MAUDE Adverse Event Report: ZIMMER BIOMET, INC. PERSONA TIBIAL CUT GUIDE; PROSTHESIS, KNEE

Model Number	N/A
Medical Device Problem Code	Mechanical Jam (2983)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	06/24/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).The event was initially reported on 0001822565-2020-02530.Complaint sample was evaluated and the reported event was confirmed.Visual evaluation of the returned device shows the drill pin stuck in a hole.Device history record (dhr) was reviewed and no discrepancies relevant to the reported event were found.A definitive root cause cannot be determined.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.
Event or Problem Description
It was reported that the drill pin got stuck to the device during an initial procedure.Attempt for further information has been made, but no further information has been provided.
Additional Manufacturer Narrative
Upon receipt of additional information, it was determined that the initial report was submitted under wrong manufacturing site and should be voided.This report will be completed under manufacturing report number 0001822565-2021-01039.
Event or Problem Description
Upon receipt of additional information, it was determined that the initial report was submitted under wrong manufacturing site and should be voided.This report will be completed under manufacturing report number 0001822565-2021-01039.

• Brand Name: PERSONA TIBIAL CUT GUIDE
• Common Device Name: PROSTHESIS, KNEE
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• MDR Report Key: 10908850
• Report Number: 0001825034-2020-04179
• Device Sequence Number: 3170357
• Product Code: HSX
• UDI-Device Identifier: 00889024582859
• UDI-Public: (01)00889024582859
• Combination Product (Y/N): N
• Initial Reporter State: IA
• Initial Reporter Country: US
• PMA/510(K) Number: K200151
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: distributor,health profession
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 04/16/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: N/A
• Device Catalogue Number: 42539905295
• Device Lot Number: 64768305
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/02/2020
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 11/18/2020
• Supplement Date Received by Manufacturer: 04/12/2021
• Initial Report FDA Received Date: 11/26/2020
• Supplement Report FDA Received Date: 04/16/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement: N/A
• Patient Sequence Number: 1