FDA Adverse Event Injury Summary report: N

TRILOGY ALUMINA INSERT

MDR report key: 4101608 · Received August 27, 2014

Report

Report Number
1822565-2014-01038
Event Type
Injury
Date Received
August 27, 2014
Date of Event
July 10, 2014
Report Date
August 1, 2014
Manufacturer
ZIMMER, INC.
Product Code
MRA
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA
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 THE PATIENT WAS REVISED TO ADDRESS PAIN AND AN AUDIBLE NOISE. DURING THE REVISION, IT WAS NOTICED THE LINER WAS BROKEN; THEREFORE, THE LINER WAS REMOVED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
522563 TRILOGY ALUMINA INSERT MRA ZIMMER, INC. 60016158

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention