BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PROLONG PARTICULAR SURFACE LPS-FLEX FIXED SIZE GH 12 MM

    MDR report key: 6371451 · Received March 2, 2017

    Report

    Report Number
    0001822565-2017-01209
    Event Type
    Injury
    Date Received
    March 2, 2017
    Date of Event
    February 16, 2016
    Report Date
    January 24, 2018
    Manufacturer
    ZIMMER, INC.
    Product Code
    JWH
    PMA / PMN Number
    PK042271
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    REPORTED EVENT WAS CONFIRMED BY REVIEW OF MEDICAL RECORDS. THE OPERATIVE NOTES WERE RECEIVED AND REVIEWED. DURING THE SURGERY IT WAS NOTIFIED THAT PATIENT HAD OBVIOUS INFECTION OF FEMORAL AND PATELLAR COMPONENTS AND COMPONENTS FOUND TO BE WELL ALIGNED. DEVICE HISTORY RECORD WAS REVIEWED AND NO DISCREPANCIES WERE FOUND. REVIEW OF THE COMPLAINT HISTORY DETERMINED THAT NO FURTHER ACTION IS REQUIRED AS NO TRENDS WERE IDENTIFIED. ROOT CAUSE WAS UNABLE TO BE DETERMINED AS THE NECESSARY INFORMATION TO ADEQUATELY INVESTIGATE THE REPORTED EVENT WAS NOT PROVIDED. THERE ARE WARNINGS IN THE PACKAGE INSERT THAT THIS TYPE OF EVENT CAN OCCUR AND RISKS ARE ADDRESSED IN RISK DOCUMENTATION. IF ANY FURTHER INFORMATION IS FOUND WHICH WOULD CHANGE OR ALTER ANY CONCLUSIONS OR INFORMATION, A SUPPLEMENTAL WILL BE FILED ACCORDINGLY. ZIMMER BIOMET WILL CONTINUE TO MONITOR FOR TRENDS.

    Additional Manufacturer Narrative · 1

    IF ANY FURTHER INFORMATION IS FOUND WHICH WOULD CHANGE OR ALTER ANY CONCLUSIONS OR INFORMATION, A SUPPLEMENTAL WILL BE FILED ACCORDINGLY. ZIMMER BIOMET WILL CONTINUE TO MONITOR FOR TRENDS.

    Additional Manufacturer Narrative · 1

    CONCOMITANT MEDICAL PRODUCTS: NEXGEN LPS-FLEX FEMORAL COMPONENT PRECOAT (00-5960-018-52, LOT 62217448). NEXGEN FLUTED STEM TIBIAL COMPONENT (00-5996-058-01, LOT 62390852). INSALL/BURSTEIN II MODULAR KNEE SYSTEM PATELLAR COMPONENT (00-5220-019- 00, 62236653). PALACOS R RADIOPAQUE BONE CEMENT (00-1112-140-01, 76584339 X 2). THIS REPORT IS NUMBER 2 OF 3 MDRS FILED FOR THE SAME PATIENT (REFERENCE 0001822565-2017-01223 AND 0002648920-2017-00086).

    Description of Event or Problem · 1

    IT WAS ALSO REPORTED IN THE MEDICAL RECORDS THAT THE PATIENT SHOWED SIGNS OF OSTEOLYSIS UNDER THE FEMORAL AND PATELLAR COMPONENTS.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A PATIENT UNDERWENT A TOTAL KNEE ARTHROPLASTY REVISION DUE TO INFECTION. THE ARTICULAR SURFACE WAS IMPLANTED LESS THAN ONE YEAR PRIOR TO INFECTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    155630 PROLONG PARTICULAR SURFACE LPS-FLEX FIXED SIZE GH 12 MM PROSTHESIS, KNEE JWH ZIMMER, INC. N/A 62491561

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR Hospitalization| R