MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2019-12-30 for INTERCHANGEABLE HUMERAL ASSEMBLY FOR CEMENTED USE N/A 32810502604 manufactured by Zimmer Biomet, Inc..
[173171064]
(b)(4). It is unknown if product will be returning to zimmer biomet and the investigation is in process. Once the investigation has been completed, a follow-up report will be submitted. Product not returned.
Patient Sequence No: 1, Text Type: N, H10
[173171065]
It was reported patient has been indicated for revision due to unknown reasons. No revision has been reported to date. Attempts to obtain additional information have been made; however, no more is available at this time.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0001822565-2019-05495 |
| MDR Report Key | 9532002 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-12-30 |
| Date of Report | 2020-03-11 |
| Date Mfgr Received | 2020-02-13 |
| Device Manufacturer Date | 2015-09-29 |
| Date Added to Maude | 2019-12-30 |
| 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 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | INTERCHANGEABLE HUMERAL ASSEMBLY FOR CEMENTED USE |
| Generic Name | ELBOW, PROSTHESIS |
| Product Code | JDC |
| Date Received | 2019-12-30 |
| Model Number | N/A |
| Catalog Number | 32810502604 |
| Lot Number | 63121644 |
| 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. Other | 2019-12-30 |