BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN ZIMMER TIBIAL COMPONENT

    MDR report key: 6766862 · Received August 4, 2017

    Report

    Report Number
    0001822565-2017-05317
    Event Type
    Injury
    Date Received
    August 4, 2017
    Date of Event
    July 21, 2014
    Report Date
    August 4, 2017
    Manufacturer
    ZIMMER, INC.
    Product Code
    JWH
    PMA / PMN Number
    PNI
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). MICHAEL E. BEREND (2014) "USE OF SCREWS AND CEMENT IN REVISION TKA WITH PRIMARY OR REVISION SPECIFIC PROSTHESIS WITH UP TO 17 YEARS FOLLOWUP" THE JOURNAL OF ARTHROPLASTY, 30 (2015) 86-89. COMMON DEVICE NAME: - ZIMMER PRODUCTS REPORTED IN THIS ARTICLE INCLUDE INSALL-BURSTEIN, LEGACY NEXGEN AND LEGACY CONSTRAINED CONDYLAR KNEE (LCCK). CONCOMITANT DEVICES ¿ UNKNOWN ZIMMER FEMORAL COMPONENT CATALOG #: NI LOT #: NI. INITIAL CONTACT NAME ¿ THIS JOURNAL ARTICLE WAS WRITTEN BY MICHAEL E. BEREND, MERRILL A. RITTER, E. MICAEL KEATING, MICHAEL D. JACKSON, KENNETH E. DAVIS AND ROBERT A. MALINZAK. THE COMPLAINT DEVICE IS NOT EXPECTED FOR RETURN CURRENTLY, BUT A SUPPLEMENTAL MEDWATCH 3500A WILL BE SUBMITTED UPON RECEIPT OF ADDITIONAL INFORMATION. THE REPORTED EVENT WAS UNABLE TO BE CONFIRMED DUE TO LIMITED INFORMATION RECEIVED FROM THE CUSTOMER. A DEVICE HISTORY RECORD REVIEW WAS UNABLE TO BE PERFORMED AS THE LOT NUMBER OF THE DEVICE INVOLVED IN THE EVENT IS UNKNOWN. A COMPLAINT HISTORY REVIEW WAS UNABLE TO BE PERFORMED AS THE PART AND LOT NUMBERS ARE UNKNOWN. A ROOT CAUSE WAS UNABLE TO BE DETERMINED AS THE NECESSARY INFORMATION TO ADEQUATELY INVESTIGATE THE REPORTED EVENT WAS NOT PROVIDED. THIS REPORT IS NUMBER 1 OF 2 MDRS FILED FOR THE SAME PATIENT (REFERENCE 0001822565-2017-05317 05318).

    Description of Event or Problem · 1

    IT IS REPORTED THAT ONE (1) PATIENT UNDERWENT A KNEE ARTHROPLASTY REVISION DUE TO ASEPTIC TIBIAL LOOSENING AND PROSTHESIS RETENTION OF THE FEMORAL COMPONENT POST-OPERATIVELY. NO ADDITIONAL PATIENT CONSEQUENCES WERE REPORTED. ATTEMPTS HAVE BEEN MADE TO RETRIEVE ADDITIONAL INFORMATION, BUT NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    549350 UNKNOWN ZIMMER TIBIAL COMPONENT PROSTHESIS, KNEE JWH ZIMMER, INC. N/A NI

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R