BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HWAL ARCOMXL ALLPOLY 36IDX54OD

    MDR report key: 7752755 · Received August 6, 2018

    Report

    Report Number
    0001825034-2017-10873
    Event Type
    Injury
    Date Received
    August 6, 2018
    Date of Event
    February 12, 2016
    Report Date
    August 6, 2018
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    JDI
    PMA / PMN Number
    PK042051
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SP
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). (B)(6). CONCOMITANT MEDICAL PRODUCTS: 22-300817 ARCOS 17 X 150 MM SPL TPR DIST HA 047050, PT-125464 REGENEREX ACET SHELL 64ODX54ID 478150, 22-301303 ARCOS CON SZ C STD 60 MM HA 682750, 650-0840 36 MM COCR BIOMET FEM HD -3 NK 1524524, 103531 TI LOW PROFILE SCREW 6.5 X 20 MM 3187124, 103531 TI LOW PROFILE SCREW 6.5 X 20 MM 3147716, 103533 TI LOW PROFILE SCREW 6.5 X 30 MM 2915874, 103536 TI LOW PROFILE SCREW 6.5 X 45 MM 2846235, UNKNOWN CERCLAGE WIRES. THE COMPLAINT CAN BE CONFIRMED BASED ON THE INFORMATION PROVIDED FROM THE CLINICAL STUDY AND X-RAYS. THE X-RAY REVIEW SHOWS OVERALL FIT AND ALIGNMENT OF THE IMPLANT IS APPROPRIATE. NO OBVIOUS SIGNS OF LOOSENING OR RADIOLUCENCY SEEN ON THESE IMAGES. RADIOLOGIST NOTED A PROXIMAL CERCLAGE WIRE IS FRACTURED ON THE 1 YR AND 3 YR IMAGE. RADIOLOGIST NOTES PERSISTENT FRACTURE INVOLVING THE PROXIMAL LEFT FEMORAL DIAPHYSIS ON IMMEDIATE POST OP AND 3 YR IMAGE. DEVICE HISTORY RECORDS REVIEWED AND IDENTIFIED NO DEVIATIONS OR ANOMALIES THAT COULD LEAD TO THE REPORTED EVENT. A DEFINITIVE ROOT CAUSE CANNOT BE PROVIDED BASED ON THE INFORMATION PROVIDED. THE WIRE FRACTURE AND DIAPHYSIS FRACTURE COULD BE CONTRIBUTING FACTORS TO THE REPORTED PATIENT¿S CONDITION. IT IS UNCONFIRMED IF THE FRACTURE IS A NONUNION OF THE PREVIOUS FRACTURE OR A NEW ONE FORMED AS A RESULT OF THE CERCLAGE WIRE FRACTURE. 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. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2017-10871, 0001825034-2017-10874, 0001825034-2017-10872.

    Description of Event or Problem · 1

    IT WAS REPORTED FROM A CLINICAL STUDY THAT THE PATIENT WAS EXPERIENCING MODERATE LEFT HIP PAIN, DIFFICULTIES AMBULATING, DIFFICULTY PERFORMING ACTIVITIES OF DAILY LIVING AT A THREE YEAR FOLLOW UP AFTER PRIMARY SURGERY. NO OTHER ADDITIONAL INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    593863 HWAL ARCOMXL ALLPOLY 36IDX54OD HIP PROSTHESIS JDI ZIMMER BIOMET, INC. N/A 710780

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Other