FDA Adverse Event Injury Summary report: N

OXF TWIN-PEG CMNTD FEM MD PMA

MDR report key: 7221320 · Received January 26, 2018

Report

Report Number
3002806535-2018-00183
Event Type
Injury
Date Received
January 26, 2018
Date of Event
November 22, 2016
Report Date
March 5, 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
NC, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

(B)(4). CONCOMITANT MEDICAL PRODUCTS: OXF UNI TIB TRAY SZ B LM PMA , ITEM 154720, LOT 387640, THERAPY DATE - (B)(6) 2016, OXF ANAT BRG LT MD SIZE 4 PMA, ITEM 159548, LOT 060550, THERAPY DATE - (B)(6) 2016. 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: 3002806535-2018-00184 AND 3002806535-2018-00185.

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.

Description of Event or Problem · 1

IT WAS REPORTED THAT A PATIENT HAD A KNEE REVISION DUE TO AN UNKNOWN REASON.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
66490 OXF TWIN-PEG CMNTD FEM MD PMA KNEE PROSTHESIS NRA BIOMET UK LTD. N/A 781080

Patients

Seq Age Sex Outcome Treatment
1 67 YR Hospitalization| R