BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRILOGY SHELL WITH CLUSTER HOLES

    MDR report key: 3940583 · Received June 25, 2014

    Report

    Report Number
    2648920-2014-00159
    Event Type
    Injury
    Date Received
    June 25, 2014
    Report Date
    May 29, 2014
    Manufacturer
    ZIMMER
    Product Code
    LPH
    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 HAS REVISED DUE TO PAIN, DISLOCATION AND INSTABILITY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    369735 TRILOGY SHELL WITH CLUSTER HOLES LPH ZIMMER 61203781

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention LOT #61034204| CATALOG #00630506436, TRILOGY LONGEVITY POLY LINER