BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRILOGY SHELL WITH HOLES

    MDR report key: 3150103 · Received May 30, 2013

    Report

    Report Number
    2648920-2013-00121
    Event Type
    Injury
    Date Received
    May 30, 2013
    Date of Event
    April 12, 2013
    Report Date
    April 30, 2013
    Manufacturer
    ZIMMER
    Product Code
    LPH
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    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 WAS REVISED DUE TO THE CUP LOOSENING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    237615 TRILOGY SHELL WITH HOLES LPH ZIMMER 61321067

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Required Intervention 6.5MM TRILOGY SCREWS (X3): CATALOG #UNK, LOT #UNK