BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VNGD DIST FEM AUG 60X5 RL/LM

    MDR report key: 6679201 · Received June 29, 2017

    Report

    Report Number
    0001825034-2017-04462
    Event Type
    Injury
    Date Received
    June 29, 2017
    Date of Event
    November 2, 2016
    Report Date
    October 20, 2017
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    JWH
    PMA / PMN Number
    PK023546
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). CONCOMITANT MEDICAL PRODUCT:- BMT SPLINED KNEE STM 14X80, CATALOG# 141614, LOT# 408790. BIOMET ILOK STEM TIB TRAY 67MM, CATALOG# 141512, LOT# 286860. BMT SPLINED KNEE STM 18X80, CATALOG# 141618, LOT# 680890. VNGD TI FEM SSK 60MM RT, CATALOG# CP113122, LOT# 843030. VNGD DIST FEM AUG 60X5 RL/LM, CATALOG# 184102, LOT# 235510. BIOMET TIB BLOCK 6MM 67, CATALOG# 141742, LOT# 430780. BIOMET TIB BLOCK 6MM 67, CATALOG# 141742, LOT# 513220. VNGD SSKPSC TIB BRG S 14X63/67, CATALOG# 183824, LOT# 846640. CUSTOMER HAS INDICATED THAT THE PRODUCT WILL NOT BE RETURNED TO ZIMMER BIOMET FOR INVESTIGATION DUE UNKNOWN LOCATION OF THE DEVICE. THE INVESTIGATION IS IN PROCESS. ONCE THE INVESTIGATION HAS BEEN COMPLETED, A FOLLOW-UP MDR WILL BE SUBMITTED. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2017-04461 AND 04477.

    Additional Manufacturer Narrative · 1

    THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2017-04477, 0001825034-2017-04461, 0001825034-2017-09473. REPORTED EVENT WAS UNABLE TO BE CONFIRMED DUE TO LIMITED INFORMATION RECEIVED FROM THE CUSTOMER. 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. 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 PATIENT WAS REVISED DUE TO LOOSENING APPROXIMATELY FIVE YEARS POST IMPLANTATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    457290 VNGD DIST FEM AUG 60X5 RL/LM PROSTHESIS, KNEE JWH BIOMET ORTHOPEDICS 235510

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Hospitalization| R