BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MAXIM BIOMET FINNED STEM 80X15 MM

    MDR report key: 6453583 · Received April 3, 2017

    Report

    Report Number
    0001825034-2017-02361
    Event Type
    Injury
    Date Received
    April 3, 2017
    Date of Event
    April 1, 2014
    Report Date
    April 14, 2017
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    JWH
    PMA / PMN Number
    PK142933
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4) . CONCOMITANT MEDICAL PRODUCT: BIOMET CEMENTLESS PRIMARY TIBIAL TRAYS 75MM, CATALOG #: 141264, LOT #: 982870. VANGUARD CEMENTLESS CR POROUS FEMORAL, CATALOG #: 183070, LOT #: 539360. VANGUARD HXLPE CR LIP TIBIAL BEARING, CATALOG #: 183540, LOT # 072400. CUSTOMER HAS NOT INDICATED THAT THE PRODUCT WILL BE RETURNED TO ZIMMER BIOMET FOR INVESTIGATION. THE INVESTIGATION IS IN PROGRESS. ONCE THE INVESTIGATION HAS BEEN COMPLETED, A FOLLOW-UP MDR WILL BE SUBMITTED.

    Additional Manufacturer Narrative · 1

    REPORTED EVENT WAS UNABLE TO BE CONFIRMED DUE TO LIMITED INFORMATION RECEIVED FROM THE CUSTOMER. REVIEW OF DEVICE HISTORY RECORD FOUND ONE PIECE WAS RE-ETCHED BECAUSE THE PART NUMBER COULD NOT BE READ. REVIEW OF THE COMPLAINT HISTORY DETERMINED THAT NO FURTHER ACTION IS REQUIRED AS NO WERE TRENDS IDENTIFIED. ROOT CAUSE WAS UNABLE TO BE DETERMINED AS THE NECESSARY INFORMATION TO ADEQUATELY INVESTIGATE THE REPORTED EVENT WAS NOT PROVIDED. 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.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT FOLLOWING A TOTAL KNEE ARTHROPLASTY, THE PATIENT UNDERWENT A REVISION SURGERY DUE TO UNKNOWN REASONS. ATTEMPTS HAVE BEEN MADE AND ADDITIONAL INFORMATION ON THE REPORTED EVENT IS UNAVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    236629 MAXIM BIOMET FINNED STEM 80X15 MM PROSTHESIS, KNEE JWH BIOMET ORTHOPEDICS 848740 

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Hospitalization| R