BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN ZIMMER M/L TAPER STEM

    MDR report key: 3022661 · Received March 22, 2013

    Report

    Report Number
    1822565-2013-00516
    Event Type
    Injury
    Date Received
    March 22, 2013
    Report Date
    February 21, 2013
    Manufacturer
    ZIMMER, INC.
    Product Code
    KWY
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    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 PAIN WAS REVISED DUE TO PAIN. DURING THE REVISION, THE SURGEON NOTED TRUNNION CORROSION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    119181 UNKNOWN ZIMMER M/L TAPER STEM HIP PROSTHESIS KWY ZIMMER, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Required Intervention