MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,health profession report with the FDA on 2016-08-05 for UNKNOWN HUMERAL COMPONENT N/A manufactured by Zimmer Biomet, Inc..
[135218530]
(b)(4). Customer has indicated that the product will not be returned to zimmer biomet for investigation, discarded. 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: 0001822565-2019-00383.
Patient Sequence No: 1, Text Type: N, H10
[135218531]
It was reported that the patient was patient underwent a revision procedure due to massive bone loss. No additional information is available form this event
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1822565-2019-00379 |
| MDR Report Key | 5850775 |
| Report Source | DISTRIBUTOR,HEALTH PROFESSION |
| Date Received | 2016-08-05 |
| Date of Report | 2019-02-06 |
| Date of Event | 2018-10-05 |
| Date Mfgr Received | 2016-08-03 |
| Date Added to Maude | 2016-08-05 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. CHRISTINA ARNT |
| Manufacturer Street | 56 E. BELL DR. |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal | 46582 |
| Manufacturer Phone | 5745273773 |
| Manufacturer G1 | ZIMMER BIOMET, INC. |
| Manufacturer Street | 56 E. BELL DRIVE |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 46582 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | N/A |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | UNKNOWN HUMERAL COMPONENT |
| Generic Name | PROSTHESIS, ELBOW |
| Product Code | KWJ |
| Date Received | 2016-08-05 |
| Model Number | N/A |
| Catalog Number | NI |
| Lot Number | NI |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ZIMMER BIOMET, INC. |
| Manufacturer Address | 56 E. BELL DRIVE WARSAW IN 46582 US 46582 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2016-08-05 |