BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DUROM ACETABULAR COMPONENT 44/38 CODE D

    MDR report key: 7285570 · Received February 21, 2018

    Report

    Report Number
    0009613350-2018-00269
    Event Type
    Injury
    Date Received
    February 21, 2018
    Date of Event
    November 3, 2016
    Report Date
    February 21, 2018
    Manufacturer
    ZIMMER GMBH
    Product Code
    KWA
    PMA / PMN Number
    PN/A
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    ATTORNEY

    Narratives

    Additional Manufacturer Narrative · 1

    CONCOMITANT MEDICAL PRODUCT: METASUL LDH, HEAD ADAPTER, S, -4, TAPER 12/14-18/20 CATALOG #: 0100185145 ; LOT #: 2275145, METASUL LDH, HEAD, 38, CODE D, TAPER 18/20 CATALOG #: 0100181380 ; LOT #: 2160685, DISTAL CENTRALIZER 9 MM O.D. CATALOG #: 00785900900 ; LOT #: 60289340, FEMORAL STEM CEMENTED 12/14 NECK TAPER CATALOG #: 00785701100 ; LOT #: 60028641 THERAPY DATE : (B)(6) 2016. THE MANUFACTURER DID NOT RECEIVE DEVICES OR X-RAYS FOR REVIEW. WHERE LOT NUMBERS WERE RECEIVED FOR THE DEVICES, THE DEVICE HISTORY RECORDS WERE REVIEWED AND FOUND TO BE CONFORMING. BASED ON AN EXTENSIVE INVESTIGATION OF EVENTS REPORTED FROM SEVERAL USER FACILITIES OUTSIDE THE USA, ZIMMER IDENTIFIED THAT THE MOST PROBABLE CAUSE FOR THE OUTCOME OBSERVED WAS A LOOSE OR UNSTABLE CUP THAT RESULTED FROM USE OF SURGICAL TECHNIQUES NOT CONSISTENT WITH THE MANUFACTURER'S RECOMMENDATIONS. AS A CORRECTIVE ACTION, A RETRAINING PROGRAM FOR USERS OUTSIDE THE USA WAS INITIATED IN NOVEMBER 2009 AND REPORTED TO THE NATIONAL COMPETENT AUTHORITIES AS REQUIRED. THE DUROM CUP REPORTED IN THIS CASE IS NOT MARKETED IN THE USA. A SIMILAR CUP, COMPATIBLE WITH THE METASUL LDH FEMORAL HEAD, IS CLEARED IN THE USA AND A CORRECTIVE ACTION FOR THIS PRODUCT WAS REPORTED TO THE FDA IN JULY 2008 AS NOTIFICATION Z-2415/2426-2008. SINCE THIS CASE IS RELATED TO THE ISSUES FOR WHICH ZIMMER IMPLEMENTED A CORRECTIVE ACTION THERE WILL BE NO FURTHER INVESTIGATION. (B)(4).

    Description of Event or Problem · 1

    PATIENT WAS IMPLANTED ON THE LEFT SIDE AND UNDERWENT REVISION SURGERY DUE TO LOOSENING AND PSEUDO TUMOUR. THIS IS A BILATERAL CLAIM. RIGHT SIDE COMPLAINT: (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    130733 DUROM ACETABULAR COMPONENT 44/38 CODE D DUROM ACETABULAR COMPONENT AND METASUL LDH KWA ZIMMER GMBH N/A 2209464

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Hospitalization| R