MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,health professional report with the FDA on 2018-08-03 for SULOX, HEAD, M? 32/0, TAPER 12/14 N/A 17.32.06 manufactured by Zimmer Gmbh.
[115894752]
(b)(4). Concomitant medical products and therapy dates: detail of product : associated item number: 00000004265, item name: alloft-s alloclassic shl 52/ii, lot #: 2452071. Associated item number: 290039090, item name: cls spotorno, stem, 135, uncemented, 9. 0, taper 12/14, lot #: 2437399. Associated item number: 0100013509, item name: durasul, alpha insert, hooded, ii/32, lot #: 2456420. The manufacturer received x-rays and other source documents for review. The manufacturer did not receive the device for investigation. The device history records were reviewed and found to be conforming. Additional information has been requested and is currently not available. A cause for this specific event cannot be ascertained from the information provided. As soon as supplemental information becomes available, an updated report will be submitted. (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[115894753]
It was reported that about 9 years after the implantation the patient underwent revision surgery due the fracture of the implant.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0009613350-2018-00748 |
| MDR Report Key | 7745977 |
| Report Source | FOREIGN,HEALTH PROFESSIONAL |
| Date Received | 2018-08-03 |
| Date of Report | 2018-11-29 |
| Date of Event | 2018-06-21 |
| Date Mfgr Received | 2018-11-15 |
| Device Manufacturer Date | 2008-06-17 |
| Date Added to Maude | 2018-08-03 |
| 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 GMBH |
| Manufacturer Street | SULZER ALLEE 8 SULZER INDUSTRIE PARK |
| Manufacturer City | WINTERTHUR 8404 |
| Manufacturer Country | SZ |
| Manufacturer Postal Code | 8404 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | N/A |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SULOX, HEAD, M? 32/0, TAPER 12/14 |
| Generic Name | N/A |
| Product Code | KWB |
| Date Received | 2018-08-03 |
| Returned To Mfg | 2018-07-25 |
| Model Number | N/A |
| Catalog Number | 17.32.06 |
| Lot Number | 2460651 |
| Device Expiration Date | 2013-05-31 |
| Operator | LAY USER/PATIENT |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ZIMMER GMBH |
| Manufacturer Address | SULZER ALLEE 8 SULZER INDUSTRIE PARK WINTERTHUR 8404 SZ 8404 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2018-08-03 |