MAUDE Adverse Event Report: ZIMMER BIOMET, INC. VANGUARD PS TIB BRG 71/75 X 10 MM; PROSTHESIS, KNEE

Model Number N/A

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Insufficient Information (4580)

Event Type  Injury  

Event Description

It was reported that patient had right total knee arthroplasty.The patient had physical therapy for right total knee reconstruction 8 years, 4 months post procedure for 2 months.Patient was revised on an unknown date and unknown reason.'patient states on pictures, this is what was removed from my knee.' no additional information available.

Manufacturer Narrative

(b)(4).Visual examination of the pictures provided within the medical records found black tissue was removed from the knee.No product was returned or pictures provided of the devices; visual and dimensional evaluations could not be performed.Review of the device history record(s) identified no deviations or anomalies during manufacturing related to the reported event.The reported products were reviewed for compatibility with no issues noted.Medical records were provided and reviewed by a health care professional.Review found knee pain 15 day¿s post op.X-ray review found implants were in good position.No dvt.Further medical records were not provided.This complaint was not confirmed.A definitive root cause cannot be determined.No corrective actions, preventive actions, or field actions resulted after investigation of this event.Additional associated products and mdrs: 183108 van ps open intl fem-rt 65 65 lot# 196810 mdr: 0001825034-2021-03365; 141234 biomet cc cruciate tray 75mm mm lot# j2905890 mdr: 0001825034-2021-03366.

• Brand Name: VANGUARD PS TIB BRG 71/75 X 10 MM
• Type of Device: PROSTHESIS, KNEE
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• Manufacturer Contact: christina arnt ; 56 e. bell dr.; warsaw, IN 46582 ; 5745273773
• MDR Report Key: 13025967
• MDR Text Key: 282399511
• Report Number: 0001825034-2021-03367
• Device Sequence Number: 1
• Product Code: HRY
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K171054
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Health Professional,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 12/17/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/17/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 08/31/2017
• Device Model Number: N/A
• Device Catalogue Number: 183640
• Device Lot Number: 808960
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 11/24/2021
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 08/24/2012
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Removal/Correction Number: N/A
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention; Hospitalization
• Patient Sex: Male