BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZIMMER

    MDR report key: 41487 · Received October 1, 1996

    Report

    Report Number
    33141-1996-00021
    Event Type
    Injury
    Date Received
    October 1, 1996
    Date of Event
    September 26, 1996
    Report Date
    September 27, 1996
    Manufacturer
    ZIMMER, INC.
    Product Code
    HTG
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    IN, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    PT COMPLAINED OF PAIN. IT WAS FOUND THAT THE PLASTIC HAD SEPARATED FROM THE METAL. THE PATELLA WAS REPLACED WITH A 00-5220-012-00. THE PATELLA WAS A WHITE POROUS IMPLANT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ZIMMER Implant MG PATELLA HTG ZIMMER, INC. * NA

    Patients

    Seq Age Sex Outcome Treatment
    1 83 YR Required Intervention