BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BIOMET MODULAR FINNED STEM WITH SCREW 80MM

    MDR report key: 8818442 · Received July 23, 2019

    Report

    Report Number
    0001825034-2019-03170
    Event Type
    Injury
    Date Received
    July 23, 2019
    Report Date
    August 27, 2019
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    JWH
    PMA / PMN Number
    K142933
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 0

    UPON RECEIPT OF ADDITIONAL INFORMATION, IT WAS IDENTIFIED THAT THIS DEVICE DID NOT CAUSE OR CONTRIBUTE TO THE REPORTED EVENT. THIS COMPLAINT IS BEING REPORTED UNDER 0001825034-2019-03172.

    Description of Event or Problem · 0

    NO FURTHER EVENT INFORMATION AVAILABLE AT THE TIME OF THIS REPORT.

    Additional Manufacturer Narrative · 1

    (B)(4). CONCOMITANT MEDICAL PRODUCTS¿ VANGUARD POSTERIOR STABILIZED E1 ANTIOXIDANT INFUSED TIBIAL BEARING 14MM X 71/75MM CATALOG #: EP-183744 LOT #: 356330, REGENEREX PRIMARY TIBIAL TRAY WITH LOCKING BAR 71MM CATALOG #: 141273 LOT #: 590690, REGENEREX SERIES A 3 PEG PATELLA 31MM CATALOG #: 141356 LOT #: 561780, VANGUARD POSTERIOR STABILIZED OPEN BOX FEMORAL COMPONENT LEFT 65MM CATALOG #: 184528 LOT #: 097110. THE COMPLAINANT HAS INDICATED THAT THE PRODUCT WILL NOT BE RETURNED TO ZIMMER BIOMET FOR INVESTIGATION, AS THE DEVICES REMAIN IMPLANTED. THE INVESTIGATION IS IN PROCESS. ONCE THE INVESTIGATION HAS BEEN COMPLETED, A FOLLOW-UP MDR WILL BE SUBMITTED. MULTIPLE MDR REPORTS WERE FILED FOR THIS PATIENT; PLEASE SEE ALL REPORTS ASSOCIATED WITH THIS EVENT. 001825034-2019-03169, 001825034-2019-03170, 001825034-2019-03171, 001825034-2019-03172, 001825034-2019-03173. INVESTIGATION INCOMPLETE.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT IS ALLEGING HARM CAUSED BY THE DEVICE FOLLOWING KNEE ARTHROPLASTY; HOWEVER THE NATURE OF THE HARM IS UNKNOWN AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    609630 BIOMET MODULAR FINNED STEM WITH SCREW 80MM PROSTHESIS, KNEE JWH ZIMMER BIOMET, INC. N/A 951040

    Patients

    Seq Age Sex Outcome Treatment
    1 Other