BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VANGUARD CR FEMORAL 70 MM RIGHT-INTERLOK

    MDR report key: 6297216 · Received February 2, 2017

    Report

    Report Number
    0001825034-2017-00412
    Event Type
    Injury
    Date Received
    February 2, 2017
    Date of Event
    October 18, 2016
    Report Date
    May 18, 2017
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    JWH
    PMA / PMN Number
    PK023546
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE REVIEW OF DEVICE HISTORY RECORDS DISCOVERED NO DEVIATIONS OR ABNORMALITIES. THE FOLLOWING COMPONENTS WERE REVIEWED FOR COMPATIBILITY WITH NO ISSUES NOTED. THESE DEVICES ARE USED FOR TREATMENT. ROOT CAUSE COULD NOT BE DETERMINED WITH INFORMATION AVAILABLE. NO CORRECTIVE ACTIONS, PREVENTIVE ACTIONS, OR FIELD ACTIONS RESULTED AFTER INVESTIGATION OF THIS EVENT.

    Additional Manufacturer Narrative · 1

    CONCOMITANT PRODUCTS: ITEM 141314, BIOMET FINNED PRI STEM 40 MM WITH SCREW, LOT 082960. ITEM 184768, VANGUARD SERIES A STANDARD PATELLA, LOT 772770. ITEM 141276, BIOMET REGENENEREX PRIMARY TIBIAL TRAY WITH LOCKING BAR, LOT 090580. ITEM EP-183460, VANGUARD CR TIBIAL BEARING, LOT 571090. THIS REPORT IS NUMBER 3 OF 5 MDRS FILED FOR THE SAME PATIENT (REFERENCE 0001825034-2017-00409/0001825034-2017-0040/0001825034-2017-00411/0001825034-2017-00410/0001825034-2017-00412).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT PATIENT UNDERWENT A REVISION PROCEDURE DUE TO PAIN AND LACK OF MOTION APPROXIMATELY SIXTEEN (16) MONTHS POST IMPLANTATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    81614 VANGUARD CR FEMORAL 70 MM RIGHT-INTERLOK PROSTHESIS, KNEE JWH BIOMET ORTHOPEDICS N/A 909410

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R