BEUDAMED
    FDA Adverse Event Injury Summary report: N

    NEXGEN LCCK ARTICULAR SURFACE

    MDR report key: 3031987 · Received March 28, 2013

    Report

    Report Number
    1822565-2013-00554
    Event Type
    Injury
    Date Received
    March 28, 2013
    Date of Event
    February 26, 2013
    Report Date
    February 26, 2013
    Manufacturer
    ZIMMER INC
    Product Code
    JWH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SZ
    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 PATIENT WAS REVISED DUE TO A FALL WHICH LOOSENED THE SCREW AND BROKE THE POLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    128656 NEXGEN LCCK ARTICULAR SURFACE JWH ZIMMER INC

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Required Intervention