BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN ZIMMER STEM

    MDR report key: 5150797 · Received October 14, 2015

    Report

    Report Number
    1822565-2015-02154
    Event Type
    Injury
    Date Received
    October 14, 2015
    Report Date
    September 18, 2015
    Manufacturer
    ZIMMER INC
    Product Code
    KWZ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    NO DEVICE OR PHOTOS WERE RECEIVED; THEREFORE THE CONDITION OF THE DEVICE IS UNKNOWN. THE PART AND LOT NUMBER OF THE PRODUCT IS UNKNOWN; THEREFORE THE DEVICE HISTORY RECORDS, COMPLAINT HISTORY COULD NOT BE REVIEWED. THE REPORTED DEVICE IS USED FOR TREATMENT. IT COULD NOT BE CONFIRMED IF THE DEVICE WAS USED IN AN APPROVED AND COMPATIBLE COMBINATION. SURGICAL NOTES WERE NOT PROVIDED. IT IS UNKNOWN WHETHER THE COMPONENTS WERE IMPLANTED WITH THE CORRECT FIT AND ORIENTATION AS PER THE SURGICAL TECHNIQUE. RELEVANT MEDICAL HISTORY AND ADHERENCE TO REHABILITATION PROTOCOL ARE UNKNOWN. IT COULD NOT BE VERIFIED IF THE REPORTED DISLOCATION CAUSED OR CONTRIBUTED TO THE LOOSE STEM. A DEFINITIVE ROOT CAUSE CANNOT BE DETERMINED WITH THE INFORMATION PROVIDED.

    Additional Manufacturer Narrative · 1

    INFORMATION WAS RECEIVED VIA PUBLISHED LITERATURE. PLEASE REFERENCE LITERATURE AT THE FOLLOWING LOCATION: HTTP://LINK.SPRINGER.COM/ARTICLE/10.1007%2FS11999-013-3167-4/FULLTEXT.HTML (B)(4). THIS REPORT WILL BE AMENDED WHEN OUR INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    IT IS REPORTED ONE PATIENT EXPERIENCED DISLOCATION WHICH REQUIRED REVISION OF A LOOSE STEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    677519 UNKNOWN ZIMMER STEM HIP PROSTHESIS KWZ ZIMMER INC

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention