FDA Adverse Event Injury Summary report: N

OXF ANAT BRG RT MD SIZE 4 PMA

MDR report key: 6947877 · Received October 13, 2017

Report

Report Number
3002806535-2017-00943
Event Type
Injury
Date Received
October 13, 2017
Date of Event
September 13, 2017
Report Date
March 1, 2018
Manufacturer
BIOMET UK LTD.
Product Code
NRA
PMA / PMN Number
PN/A
Removal / Correction Number
N/A
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

(B)(4). THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. REPORTED EVENT WAS UNABLE TO BE CONFIRMED DUE TO LIMITED INFORMATION RECEIVED FROM CUSTOMER. DEVICE HISTORY RECORD (DHR) WAS REVIEWED AND NO DISCREPANCIES WERE FOUND. 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.

Additional Manufacturer Narrative · 1

(B)(4). THE INVESTIGATION IS IN PROCESS. ONCE THE INVESTIGATION HAS BEEN COMPLETED, A FOLLOW-UP MDR WILL BE SUBMITTED. MULTIPLE MDR'S WERE SUBMITTED FOR THIS EVENT. PLEASE SEE REPORTS: 3002806535-2017-00941, 3002806535-2017-00942. (B)(4). CONCOMITANT MEDICAL PRODUCTS: 277325 STRYKER OP RCP 76.0X11.7 LOT 174879; 1506090 LOCKING SCREW PARTIALLY THREAD ED 5,0MMX9 LOT 904093; 159576 OXF ANAT BRG RT MD SIZE 4 PMA LOT 2115062; 154723 OXF UNI TIB TRAY SZ C RM PMA LOT 2070504; 154601 OXFORD UNI FEMORAL MD LOT 2169305.

Description of Event or Problem · 1

IT WAS REPORTED THE PATIENT WAS REVISED DUE TO UNKNOWN REASONS. NO PATIENT CONSEQUENCES WERE REPORTED AND NO FURTHER INFORMATION IS AVAILABLE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
728820 OXF ANAT BRG RT MD SIZE 4 PMA PROSTHESIS, KNEE NRA BIOMET UK LTD. N/A 2115062

Patients

Seq Age Sex Outcome Treatment
1 67 YR Hospitalization| R