BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZIMMER

    MDR report key: 93066 · Received May 21, 1997

    Report

    Report Number
    39747-1997-00001
    Event Type
    Injury
    Date Received
    May 21, 1997
    Date of Event
    March 25, 1997
    Report Date
    May 14, 1997
    Manufacturer
    ZIMMER, INC.
    Product Code
    LOD
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    IL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    HIP REVISION, FEMORAL STEM, PRE-OP DIAGNOSIS ASEPTIC LOOSENING LEFT HIP, OTHER DEVICE USED CENTRALIGN #4 STEM FEMORAL HEAD (9800-04 AND 9026-29) (LOT #64241800 AND #63979100). EXPLANTED ITEMS WERE SENT TO PATHOLOGY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ZIMMER Implant DOUGH TYPE BONE CEMENT LOD ZIMMER, INC. * 63843900

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Required Intervention UNK.