BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MAXIM ILOK ANA PRI FML 65 RT

    MDR report key: 5574467 · Received April 13, 2016

    Report

    Report Number
    0001825034-2016-01259
    Event Type
    Injury
    Date Received
    April 13, 2016
    Date of Event
    March 8, 2016
    Report Date
    March 16, 2016
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    JWH
    PMA / PMN Number
    PK915132
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    CURRENT INFORMATION IS INSUFFICIENT TO PERMIT A CONCLUSION AS TO THE CAUSE OF THE EVENT. THIS REPORT IS BASED ON ALLEGATIONS SET FORTH IN PATIENT¿S COMPLAINT, AND THE ALLEGATIONS CONTAINED THEREIN ARE UNVERIFIED. THIS REPORT IS NUMBER 1 OF 4 MDRS FILED FOR THE SAME EVENT (REFERENCE 1825034-2016-01259 / 01265 / 01267 / 01268).

    Description of Event or Problem · 1

    IT WAS REPORTED BY THE PATIENT THAT PATIENT UNDERWENT RIGHT TOTAL KNEE ARTHROPLASTY ON (B)(6) 2000. DURING THE PROCEDURE, PATIENT EXPERIENCED A DBT. SUBSEQUENTLY, PATIENT UNDERWENT LEFT TOTAL KNEE ARTHROPLASTY ON (B)(6) 2003. DURING THIS PROCEDURE, PATIENT EXPERIENCED A PULMONARY EMBOLISM. SUBSEQUENTLY, PATIENT UNDERWENT A RIGHT KNEE REVISION PROCEDURE ON (B)(6) 2016 DUE TO ALLEGATIONS OF ELEVATED METAL ION LEVELS AND POLY WEAR. IT WAS FURTHER REPORTED THAT THE TIBIAL BEARING WAS WORN, WHICH RESULTED IN THE BEARING BREAKING IN HALF. THIS REPORT IS BASED ON ALLEGATIONS SET FORTH IN PATIENT'S COMPLAINT, AND THE ALLEGATIONS CONTAINED THEREIN ARE UNVERIFIED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    229477 MAXIM ILOK ANA PRI FML 65 RT PROSTHESIS, KNEE JWH BIOMET ORTHOPEDICS N/A 136150

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Hospitalization| R