MAUDE Adverse Event Report: ZIMMER ORTHOPAEDIC MFG. LTD. FEMUR CEMENTED POSTERIOR STABILIZED STANDARD LEFT SIZE 10; PROSTHESIS, KNEE

Model Number	N/A
Medical Device Problem Codes	Adverse Event Without Identified Device or Use Problem (2993); Appropriate Device Problem Term/Code Not Available (3191)
Health Effect - Clinical Codes	Loss of Range of Motion (2032); Thrombosis/Thrombus (4440)
Date of Event	01/25/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).Procedural related complications are influenced by the 'type of surgery, patients pre-existing comorbid state, and perioperative management.' deep vein thrombosis, or dvt, occurs when a blood clot forms in one of the deep veins of the body.This can happen if a vein becomes damaged or if the blood flow within a vein slows down or stops.Total joint patients are typically placed on medication post-operative for a period of time to prevent the development of dvt/blood clot.Even with the administration of preventive medication, dvt/blood clots can still develop.Dvt within 30 days postop is considered a reportable procedure related event.As a part of dvt treatment, the patient is to take additional medication and limit walking and motion until the dvt resolves.As a result of the limited movement and lack of formal pt immediately postop, the patient was unable to achieve standard progress in knee flexion which then resulted in patient dissatisfaction with progress.Additional associated products and mdrs: 00598004702 stemmed tibial component precoat size 6, lot# j6833948, mdr: 0001822565-2021-00907.00596204212 articular surface size gh 12 mm height, lot# 63864811, mdr: 0001822565-2021-00908.
Event or Problem Description
Initial left total knee arthroplasty performed.Subsequently, the patient was diagnosed with a dvt in the left lower extremity one week post procedure, and resolved one week later.At the 1 month follow up, the patient demonstrated insufficient flexion and reported dissatisfaction with an inability to perform usual activities.The patient started physical therapy for treatment.

• Brand Name: FEMUR CEMENTED POSTERIOR STABILIZED STANDARD LEFT SIZE 10
• Common Device Name: PROSTHESIS, KNEE
• Manufacturer (Section D): ZIMMER ORTHOPAEDIC MFG. LTD.; building no 2 east park; shannon industrial estate; shannon, county clare ; EI
• MDR Report Key: 11602416
• Report Number: 3007963827-2021-00079
• Device Sequence Number: 3280150
• Product Code: JWH
• UDI-Device Identifier: 00889024229273
• UDI-Public: (01)00889024229273(17)300630(10)64729909
• Combination Product (Y/N): N
• Initial Reporter State: OR
• Initial Reporter Country: US
• PMA/510(K) Number: K113369
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: distributor,health profession
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 03/31/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Model Number: N/A
• Device Catalogue Number: 42500606801
• Device Lot Number: 64729909
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/08/2021
• Initial Report FDA Received Date: 04/01/2021
• 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
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Weight: 86