BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TPRLC 133 MP TYPE1 PPS HO 11.0

    MDR report key: 7758179 · Received August 7, 2018

    Report

    Report Number
    0001825034-2018-04806
    Event Type
    Injury
    Date Received
    August 7, 2018
    Date of Event
    December 20, 2013
    Report Date
    October 15, 2018
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    KWA
    PMA / PMN Number
    PK110400
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 0

    UDI: (B)(4). CONCOMITANT MEDICAL PRODUCTS: ITEM# 103533 TI LOW PROFILE SCREW 6.5X30MM LOT# 998640. 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 MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS 0001825034 - 2018 - 09734, 0001825034 - 2018 - 09741.

    Additional Manufacturer Narrative · 1

    (B)(4). MULTIPLE MDR'S WERE REPORTED FOR THIS EVENT. PLEASE ALSO SEE ASSOCIATED EVENTS: 0001825034 - 2018 - 04807, 0001825034 - 2018 - 04808, 0001825034 - 2018 - 04809, 0001825034 - 2018 - 04810. ADDITIONAL CONCOMITANT MEDICAL PRODUCTS: 11-363660 FEMORAL HEAD LOT 923630; 13-104154 RLC SHELL LOT 743650; EP-105994 LINER LOT UNKNOWN; 103531 SCREW LOT 283810. REPORTED INFECTION AND FEMORAL STEM LOOSENING EVENT WERE CONFIRMED DUE TO MEDICAL RECORDS RECEIVED FROM THE CUSTOMER. DHR WAS REVIEWED AND NO RELATED MANUFACTURING DEVIATIONS OR ANOMALIES WERE IDENTIFIED. ROOT CAUSE WAS UNABLE TO BE DETERMINED. 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. NOT RETURNED TO MANUFACTURER.

    Description of Event or Problem · 1

    IT WAS REPORTED THE PATIENT WAS REVISED TO ADDRESS SEVERE PAIN, GROSS INFECTION, AND LACK OF FEMORAL STEM IN-GROWTH. NO FURTHER INFORMATION IS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    600195 TPRLC 133 MP TYPE1 PPS HO 11.0 PROSTHESIS, HIP KWA ZIMMER BIOMET, INC. N/A 2921960

    Patients

    Seq Age Sex Outcome Treatment
    1 83 YR Hospitalization| R