BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZIMMER PERIARTICULAR HUMERAL PLATE

    MDR report key: 3022656 · Received March 22, 2013

    Report

    Report Number
    1822565-2013-00520
    Event Type
    Injury
    Date Received
    March 22, 2013
    Report Date
    February 21, 2013
    Manufacturer
    ZIMMER, INC.
    Product Code
    NDF
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THIS REPORT WILL BE AMENDED WHEN OUR INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE PATIENT IS EXPERIENCING A POSSIBLE ALLERGIC REACTION. X-RAYS NOTED A BROKEN SCREW.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    119441 ZIMMER PERIARTICULAR HUMERAL PLATE NDF ZIMMER, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 Other CATALOG # UNK, LOT #UNK| CATALOG #00234800714, LOT # UNK| UNKNOWN ZIMMER SCREW| PERIARTICULAR MEDICAL HUMERAL PLATE