BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZMR HIP SYSTEM FEMORAL STEM REVISION TAPER

    MDR report key: 578375 · Received March 4, 2005

    Report

    Report Number
    1822565-2005-00018
    Event Type
    Injury
    Date Received
    March 4, 2005
    Report Date
    February 3, 2005
    Manufacturer
    ZIMMER, INC.
    Product Code
    LWJ
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE DEVICES WERE IMPLANTED IN 2002. THE STEM FRACTURED POST-OP AND SURGERY IS SCHEDULED FOR 2005.

    Description of Event or Problem · 1

    THE STEM FRACTURE AND THE DEVICES WERE REVISED ON 02/13/2005.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ZMR HIP SYSTEM FEMORAL STEM REVISION TAPER HIP PROSTHESIS LWJ ZIMMER, INC. NA 79973000

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Hospitalization| R