BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRILOGY ACETABULAR SYSTEM LINER

    MDR report key: 641146 · Received October 13, 2005

    Report

    Report Number
    1822565-2005-00195
    Event Type
    Injury
    Date Received
    October 13, 2005
    Date of Event
    July 15, 2005
    Report Date
    September 12, 2005
    Manufacturer
    ZIMMER, INC.
    Product Code
    LPH
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE DEVICE WAS IMPLANTED ON APRIL 21, 1998, AND REVISED JULY 15, 2005, DUE TO BREAKAGE.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE DEVICE WAS IMPLANTED ON APRIL 1998 AND REVISED JULY 2005, DUE TO BREAKAGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TRILOGY ACETABULAR SYSTEM LINER HIP PROSTHESIS LPH ZIMMER, INC. NA 40591400

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Hospitalization| R