BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRILOGY ACETABULAR SYSTEM CONSTRAINED LINER

    MDR report key: 646375 · Received November 15, 2005

    Report

    Report Number
    1822565-2005-00216
    Event Type
    Injury
    Date Received
    November 15, 2005
    Date of Event
    June 2, 2005
    Report Date
    October 12, 2005
    Manufacturer
    ZIMMER, INC.
    Product Code
    KWZ
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE DEVICE WAS IMPLANTED 05/23/2005. THE DEVICE WAS REVISED POST-OP LATER ON DUE TO THE HEAD PULLING OUT OF THE LINER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TRILOGY ACETABULAR SYSTEM CONSTRAINED LINER HIP PROSTHESIS KWZ ZIMMER, INC. NA 60238208

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Hospitalization| R