BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VNGD PS TIB BRG 12X71/75MM

    MDR report key: 7756788 · Received August 7, 2018

    Report

    Report Number
    0001825034-2018-06316
    Event Type
    Injury
    Date Received
    August 7, 2018
    Date of Event
    June 21, 2011
    Report Date
    September 26, 2018
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    JWH
    PMA / PMN Number
    PK113550
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 0

    (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 THE CUSTOMER. DEVICE HISTORY RECORD (DHR) REVIEW WAS UNABLE TO BE PERFORMED AS THE LOT NUMBER OF THE DEVICE INVOLVED IN THE EVENT IS UNKNOWN. 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). MEDICAL PRODUCTS- VAN PS CLSD INTLK FEM-RT, CATALOG # 183208, LOT # UNKNOWN; BIOMET CC I-BEAM TRAY, CATALOG # 141224, LOT # UNKNOWN; BIOMET ARCOM 3 PEG/POST, CATALOG # UNKNOWN, LOT # UNKNOWN. OUR INVESTIGATION IS ONGOING. A FOLLOW-UP/FINAL REPORT WILL BE SUBMITTED WHEN ADDITIONAL INFORMATION BECOMES AVAILABLE. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2018-06308; 0001825034-2018-06325; 0001825034-2018-06327. REMAINS IMPLANTED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT UNDERWENT A PRIMARY TOTAL RIGHT KNEE ARTHROPLASTY. SUBSEQUENTLY, THE PATIENT FEEL AND EXPERIENCED PAIN. NO ADDITIONAL PATIENT CONSEQUENCES WERE REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    599632 VNGD PS TIB BRG 12X71/75MM PROSTHESIS, KNEE JWH ZIMMER BIOMET, INC. NI NI

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Hospitalization| O