VANGUARD - BIOMET 360 TIBIAL TRAY
Report
- Report Number
- 0001825034-2019-03370
- Event Type
- Injury
- Date Received
- August 2, 2019
- Date of Event
- July 8, 2019
- Report Date
- June 10, 2020
- Manufacturer
- ZIMMER BIOMET, INC.
- Product Code
- JWH
- PMA / PMN Number
- K093293
- Removal / Correction Number
- N/A
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MI, US
- Reporter Occupation
- PHYSICIAN
Narratives
THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY UPDATED AND ADDITIONAL INFORMATION. CONCOMITANT MEDICAL PRODUCTS : BMT 360 TIB TRAY 71MM; P/N: 185203, L/N: UNK, VG 360 DST FM AG 67.5X5 RL/LM; P/N: 185305, L/N: UNK , VNGD SSK PSC TIB BRG 12X71/75; P/N: 183882, L/N: UNK , BMT 360 TIB SM CRUCIATE WING; P/N: 185650, L/N: UNK , BMT SPLINED KNEE STM V2 15X80; P/N: 148305, L/N: UNK , BMT 360 TIB 5.0 OFFSET ADAPTER; P/N: 185211, L/N: UNK , SERIES A PAT STD; P/N: 184764, L/N: UNK, PALACOS R 1X40 SINGLE; P/N: 00111214001, L/N: UNK QTY: 3. PATIENT CODE 1930 WAS INITIALLY REPORTED IN ERROR AND SHOULD BE REMOVED. 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 - 2019 - 03372 - 1 , 0001825034 - 2019 - 03373 - 1 , 0001825034 - 2019 - 04217 , 0001825034 - 2019 - 04218 , 0001825034 - 2019 - 04219, 0001825034 - 2019 - 04223.
THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY UPDATED AND ADDITIONAL INFORMATION. UPDATED: A5, B4, B5, D4, D11, G4, G7. ADDITIONAL: H1, H2, H4, H10. D4 UDI: (B)(4). D11 MEDICAL PRODUCTS: BMT 360 TIB TRAY 71MM; P/N: 185203, L/N: 737710. VG 360 DST FM AG 67.5X5 RL/LM; P/N: 185305, L/N: 115520. VNGD SSK PSC TIB BRG 12X71/75; P/N: 183882, L/N: 246260. BMT 360 TIB SM CRUCIATE WING; P/N: 185650, L/N: 727430. BMT SPLINED KNEE STM V2 15X80; P/N: 148305, L/N: 731620. BMT 360 TIB 5.0 OFFSET ADAPTER; P/N: 185211, L/N: 198190. SERIES A PAT STD; P/N: 184764, L/N: 693590. PALACOS R 1X40 SINGLE; P/N: 00111214001, L/N: UNK QTY: 3. 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.
THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. D11: (B)(6)2019 185305 - VG 360 DST FM AG - 115520, 183882 - VNGD SSK PSC TIB BRG - 246260, 185650 - BMT 360 TIB SM CRUCIATE - 727430, 148305 - BMT SPLINED KNEE STM V2 - 731620, 185211 - BMT 360 TIB 5.0 OFFSET - 198190, 184764 - SERIES A PAT STD - 693590, 148302 - BMT SPLINED KNEE STM V2 - 139650, 185211 - BMT 360 TIB 5.0 OFFSET - 233860, 185265 - VNGD SSK 360 FEMUR - 3366083, 00111214001 - PALACOS SINGLE - UNKNOWN, 00111214001 - PALACOS SINGLE - UNKNOWN, 00111214001 - PALACOS SINGLE - UNKNOWN. THE FOLLOWING SECTIONS WERE UPDATED: B4; B5; G4; G7; H1; H2; H3; H6. NO PRODUCT WAS RETURNED OR PICTURES PROVIDED; VISUAL AND DIMENSIONAL EVALUATIONS COULD NOT BE PERFORMED. THE DHR WAS REVIEWED AND NO DISCREPANCIES RELEVANT TO THE REPORTED EVENT WERE FOUND. NO MEDICAL RECORDS WERE PROVIDED. MEDICAL RECORDS WERE PROVIDED AND REVIEWED BY A HEALTH CARE PROFESSIONAL. PATIENT WAS REVISED WITH NO COMPLICATIONS NOTED. POST-REVISION ULTRASOUND FOUND SOFT TISSUE SWELLING AND TENDINOSIS WITHOUT TEAR. PATIENT CLAIMS TO HAVE TESTED POSITIVE FOR INFECTION BUT CANNOT BE CONFIRMED DUE TO LACK OF MEDICAL RECORDS. A DEFINITIVE ROOT CAUSE CANNOT BE DETERMINED. IF ANY FURTHER INFORMATION IS FOUND WHICH WOULD CHANGE OR ALTER ANY CONCLUSIONS OR INFORMATION, A SUPPLEMENTAL REPORT WILL BE FILED ACCORDINGLY. ZIMMER BIOMET WILL CONTINUE TO MONITOR FOR TRENDS. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2019-03372-4, 0001825034-2019-03373-4, 0001825034-2019-04217-3, 0001825034-2019-04218-3, 0001825034-2019-04219-3, 0001825034-2019-04233-3, 0001825034-2020-02312, 0001825034-2020-02314, 0001825034-2020-02315.
COMPLAINT SAMPLE WAS EVALUATED VIA MEDICAL RECORDS AND THE REPORTED EVENT WAS NOT CONFIRMED. MEDICAL RECORDS WERE PROVIDED AND REVIEWED BY A HEALTH CARE PROFESSIONAL. PATIENT WAS REVISED WITH NO COMPLICATIONS NOTED. POST-REVISION ULTRASOUND FOUND SOFT TISSUE SWELLING AND TENDINOSIS WITHOUT TEAR. PATIENT CLAIMS TO HAVE TESTED POSITIVE FOR INFECTION BUT CANNOT BE CONFIRMED DUE TO LACK OF MEDICAL RECORDS. 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. A SUMMARY OF THE INVESTIGATION HAS BEEN SENT TO THE COMPLAINANT. 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.
IT WAS REPORTED THAT FOLLOWING A REVISION PROCEDURE, PATIENT IS EXPERIENCING PAIN, SWELLING AND FALLING. NO ADDITIONAL PATIENT CONSEQUENCES WERE REPORTED.
NO FURTHER EVENT INFORMATION AVAILABLE AT THE TIME OF THIS REPORT. CONSEQUENCES WERE REPORTED.
NO FURTHER EVENT INFORMATION AVAILABLE AT THE TIME OF THIS REPORT.
NO FURTHER EVENT INFORMATION AVAILABLE AT THE TIME OF THIS REPORT.
ZIMMER BIOMET COMPLAINT NUMBER: (B)(4). CONCOMITANT MEDICAL PRODUCTS: KNE-OTHER-TIBIAL TRAY-UNK; P/N: UNK, L/N: UNK; KNE-OTHER-FEMORALS-UNK; P/N: UNK, L/N: UNK; KNE-OTHER-BEARING-UNK; P/N: UNK, L/N: UNK. CUSTOMER HAS NOT INDICATED THAT THE PRODUCT WILL 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. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034 - 2019 - 03370, 0001825034 - 2019 - 03372, 0001825034 - 2019 - 03373. PRODUCT LOCATION IS UNKNOWN.
IT WAS REPORTED THAT FOLLOWING A REVISION PROCEDURE, PATIENT IS EXPERIENCING PAIN, SWELLING AND POSSIBLE INFECTION. ATTEMPTS HAVE BEEN MADE AND NO FURTHER INFORMATION HAS BEEN PROVIDED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 649101 | VANGUARD - BIOMET 360 TIBIAL TRAY | PROSTHESIS, KNEE | JWH | ZIMMER BIOMET, INC. | N/A | 737710 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 48 YR | Hospitalization| R | SEE H10 NARRATIVE| SEE H10 NARRATIVE| SEE H10 NARRATIVE| SEE H10. |