BEUDAMED
    FDA Adverse Event Death Summary report: N

    M/H 3HOLE RLC SHL NRS 58MM/L25

    MDR report key: 7763125 · Received August 8, 2018

    Report

    Report Number
    0001825034-2018-06932
    Event Type
    Death
    Date Received
    August 8, 2018
    Date of Event
    December 3, 2007
    Report Date
    September 17, 2018
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    LPH
    PMA / PMN Number
    PK030055
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). CONCOMITANT PRODUCTS: ITEM # UNKNOWN, UNKNOWN LINER, LOT # UNKNOWN; ITEM # 157448, M2A-MAGNUM MOD HD SZ 48MM, LOT # UNKNOWN; ITEM # UNKNOWN, UNKNOWN STEM, LOT # UNKNOWN. CUSTOMER HAS INDICATED THAT THE PRODUCT WILL NOT BE RETURNED TO ZIMMER BIOMET FOR INVESTIGATION. THE INVESTIGATION IS IN PROCESS. ONCE THE INVESTIGATION HAS BEEN COMPLETED, A FOLLOW-UP MDR WILL BE SUBMITTED. 0001825034 - 2018 - 06942, 0001825034 - 2018 - 06940, 0001825034 - 2018 - 06925.

    Additional Manufacturer Narrative · 1

    THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. CONCOMITANT MEDICAL PRODUCTS: ML-HD MOD CALC PROX 34B, PART 108112, LOT 940540. R/H M/H 13X220 80%(165) DISTAL, PART 11-108253, LOT 232980. 36MM COCR MOD HD STD, PART 11-363662, LOT 096120. ARCOMXL 36MM RLC LNR HW SZ25, PART XL-105915, LOT 054370. COCR CABLE SLEEVE 2.0MM, PART 120005, LOT 107130. COCR CABLE SLEEVE 2.0MM, PART 120005, LOT 777870. COCR TROCH CABLE 2.0MMX750MM, PART 120002, LOT 857330. COCR TROCH CABLE 2.0MMX750MM, PART 120002, LOT 107110. 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. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2018-06925-1, 0001825034 - 2018 - 06942 - 1, 0001825034 - 2018 - 06932 - 1 , 0001825034 - 2018 - 06940 - 1, 0001825034 - 2018 - 08983, 0001825034 - 2018 - 08984, 0001825034 - 2018 - 08985, 0001825034 - 2018 - 08986, 0001825034 - 2018 - 08987, 0001825034 - 2018 - 08988, 0001825034 - 2018 - 08989, 0001825034 - 2018 - 08991, 0001825034 - 2018 - 08992. 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 A PATIENT UNDERWENT INITIAL RIGHT TOTAL HIP ARTHROPLASTY APPROXIMATELY 11 YEARS AGO. THE PATIENT EXPIRED DUE TO GASTROINTESTINAL HEMORRHAGE APPROXIMATELY 4 MONTHS POST IMPLANTATION. NO FURTHER INFORMATION CONCERNING THE TIMELINE OF EVENTS BETWEEN HIP ARTHROPLASTY AND PATIENT DEATH HAS BEEN PROVIDED. ATTEMPTS WERE MADE TO OBTAIN ADDITIONAL INFORMATION; HOWEVER, NONE IS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    604281 M/H 3HOLE RLC SHL NRS 58MM/L25 PROSTHESIS, HIP LPH ZIMMER BIOMET, INC. N/A 081530

    Patients

    Seq Age Sex Outcome Treatment
    1 88 YR Death| H| O| R