BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TPRLC 133 MP TYPE1 PPS SO 17.0

    MDR report key: 9702159 · Received February 12, 2020

    Report

    Report Number
    0001825034-2020-00684
    Event Type
    Malfunction
    Date Received
    February 12, 2020
    Date of Event
    January 29, 2020
    Report Date
    June 16, 2020
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    KWZ
    PMA / PMN Number
    K110400
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. COMPLAINT SAMPLE WAS EVALUATED AND THE REPORTED EVENT WAS CONFIRMED. INSPECTION OF THE RETURNED DEVICE REVEALED THERE WAS DEBRIS INSIDE THE STERILE PACKAGING THAT IS CONSISTENT WITH THE APPEARANCE OF FOAM DEBRIS FROM THE FOAM PACKAGING INSIDE THE STERILE BARRIER AND BLACK DEBRIS CONSISTENT WITH POROUS MATERIAL FROM THE DEVICE. DEVICE HISTORY RECORD (DHR) WAS REVIEWED AND NO DISCREPANCIES WERE FOUND. THESE PRODUCTS WERE LIKELY CONFORMING WHEN THEY LEFT ZIMMER BIOMET CONTROL. THE ROOT CAUSE OF THE REPORTED ISSUE IS ATTRIBUTED TO TRANSIT DAMAGE CAUSING THE FOAM PACKAGING AND POROUS MATERIAL FROM DEVICE TO BECOME ABRADED AND SHED. 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 · 0

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

    Additional Manufacturer Narrative · 1

    (B)(4). CONCOMITANT MEDICAL PRODUCTS: TPRLC 133 T1 PPS HO 16X152MM, CAT# 51-104160, LOT# 6047712. TPRLC 133 T1 PPS HO 9X137MM, CAT# 51-104090, LOT# 6057369. TPRLC XR MP T1 PPS 14X113MM, CAT# 51-145140, LOT# 3545229. TPRLC XR MP T1 PPS 14X113MM, CAT# 51-145140, LOT# 2884150. TPRLC XR MP T1 PPS 17X119MM, CAT# 51-145170, LOT# 3730608 . TPRLC 133 MP TYPE1 PPS SO 17.0, CAT# 51-106170, LOT# 3669984. TPRLC XR MP T1 PPS 16X117MM, CAT# 51-145160, LOT# 3029799. FOREIGN SOURCE: (B)(6). MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2020-00679, 0001825034-2020-00680, 0001825034-2020-00681, 0001825034-2020-00682, 0001825034-2020-00683, 0001825034-2020-00685, 0001825034-2020-00686.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DEBRIS WAS FOUND IN STERILE PACKAGING WHILE INVESTIGATING STOCK. ATTEMPTS HAVE BEEN MADE AND ADDITIONAL INFORMATION ON THE REPORTED EVENT IS UNAVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    165069 TPRLC 133 MP TYPE1 PPS SO 17.0 PROSTHESIS, HIP KWZ ZIMMER BIOMET, INC. NI 3564680

    Patients

    Seq Age Sex Outcome Treatment
    1 SEE H10