BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRILOGY LONGEVITY CONSTRAINED POLY LINER

    MDR report key: 4212952 · Received October 24, 2014

    Report

    Report Number
    1822565-2014-01448
    Event Type
    Injury
    Date Received
    October 24, 2014
    Date of Event
    July 27, 2014
    Report Date
    September 24, 2014
    Manufacturer
    ZIMMER, INC.
    Product Code
    KWZ
    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 PT WAS REVISED DUE TO RECURRENT DISLOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    678890 TRILOGY LONGEVITY CONSTRAINED POLY LINER KWZ ZIMMER, INC. 62036279

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR Required Intervention LOT # 62082906, REMAINS IMPLANTED| LOT# 62381683 MFR BY ZIMMER (B)(4)| IMPLANTED| TM SHELL WITH MULTI HOLES, CATALOG# 00620205220,| VERSYS FEMORAL HEAD, CATALOG # 00801802814,