BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SHELL WITH MULTI HOLES POROUS

    MDR report key: 6736544 · Received July 24, 2017

    Report

    Report Number
    0001822565-2017-05109
    Event Type
    Injury
    Date Received
    July 24, 2017
    Date of Event
    April 18, 2014
    Report Date
    November 16, 2017
    Manufacturer
    ZIMMER, INC.
    Product Code
    LPH
    PMA / PMN Number
    PK151448
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE COMPLAINT NUMBER CORRESPONDING TO THIS MEDWATCH IS (B)(4). IT IS UNKNOWN IF THE DEVICE WILL BE RETURNED FOR ANALYSIS; HOWEVER, AN INVESTIGATION OF THE REPORTED EVENT IS IN PROGRESS. ONCE THE INVESTIGATION IS COMPLETED, A SUPPLEMENTAL MEDWATCH WILL BE SUBMITTED. CONCOMITANT MEDICAL PRODUCTS - 0106010001 AVENIR® MüLLER, STEM, 4021843, 00489400158 TRABECULAR METAL¿¢ ACETABULAR REVISION SYSTEM, BUTTRESS AUGMENT 62319561, 00489440000 TRABECULAR METAL ¿¢ ACETABULAR REVISION SYSTEM, COLUMN BUTTRESS, 61421724, 00489430000 TRABECULAR METAL¿¢ ACETABULAR REVISION SYSTEM, COLUMN BUTTRESS, 62091730, 00875706002 SHELL WITH MULTI HOLES POROUS 62509815, 00801803601 FEMORAL HEAD PRODUCT 62454687, 00875801436 CONSTRAINED LINER WITH RING 61730152, 00625006540 BONE SCREW 62460749, 00625006520 BONE SCREW 62640321, 00662406520 BONE SCREW 62603033, 00662406525 BONE SCREW 62326385, 00662406525 BONE SCREW 62395631, 00662406530 BONE SCREW 62490818, 00625006520 BONE SCREW 62466429, 00625006525 BONE SCREW 62528844. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001822565-2017-05109, 0002648920-2017-00469 & 0001822565-2017-05112.

    Additional Manufacturer Narrative · 1

    THIS FOLLOW-UP REPORT IS BEING FILED TO RELAY ADDITIONAL INFORMATION, WHICH WAS UNKNOWN AT THE TIME OF THE INITIAL MEDWATCH.

    Additional Manufacturer Narrative · 1

    THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. REPORTED EVENT WAS CONFIRMED BY REVIEW OF OPERATIVE NOTES. DHR WAS REVIEWED AND NO DISCREPANCIES WERE FOUND. REVIEW OF THE COMPLAINT HISTORY DETERMINED THAT NO FURTHER ACTION IS REQUIRED AS NO WERE TRENDS IDENTIFIED. ROOT CAUSE WAS UNABLE TO BE DETERMINED. PER PACKAGE INSERT THIS IS A KNOWN INHERENT RISK OF THE PROCEDURE. 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 BY PATIENT'S LEGAL COUNSEL THAT THE PATIENT UNDERWENT A THROMBECTOMY PROCEDURE DUE TO NUMBNESS AS A RESULT OF ILIAC ARTERY OCCLUSION. OCCLUSION WAS REPORTED TO HAVE OCCURRED DURING INITIAL PROCEDURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    517151 SHELL WITH MULTI HOLES POROUS PROSTHESIS, HIP LPH ZIMMER, INC. N/A 62509815

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR Hospitalization| R