MAUDE Adverse Event Report: BIOMET UK LTD. OXF UNI TIB TRAY SZ F RM PMA; KNEE ARTHROPLASTY

Model Number	N/A
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/17/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).Initial report.Customer has indicated that the product will not be returned to zimmer biomet for investigation (product has been retained by the patient).Medical product: oxf anat brg rt md size 5 pma*, catalog #: 159577, lot #: 074030.Medical product: oxf twin-peg cmntd fem md pma, catalog #: 161469, lot #: unknown.Multiple mdr reports were filed for this event, please see associated reports: 3002806535-2021-00100, and 3002806535-2021-000102.The investigation is in process.Once the investigation has been completed, a follow-up mdr will be submitted.Product has been retained by the patient.
Event or Problem Description
It was reported that a patient underwent an initial right knee arthroplasty on an (b)(6) 2019.Subsequently, a revision procedure due to poly dislocation was performed on (b)(6) 2021.
Event or Problem Description
It was reported that a patient underwent an initial right knee arthroplasty on an (b)(6) 2019.Subsequently, a revision procedure due to poly dislocation was performed on (b)(6) 2021.
Additional Manufacturer Narrative
(b)(4).This final report is being submitted to relay additional information.Complaint summary: as the product has not been received, the investigation was limited to the information provided; a review of device history records and complaint history.In addition, we have not been provided with x-rays or any supporting documentation which could provide additional information.A review of the manufacturing history records confirms no abnormalities or deviations reported, 1 scarp piece found for item 159577.A review of the manufacturing history could not be performed as lot number is unknown for item 161469.A review of the complaint database over the last 3 years has found 4 similar complaints reported with the item 159577, (b)(4) similar complaint reported with the item 154776 and (b)(4) similar complaints reported with the item 161469 (including initiating complaint).Without the opportunity to examine the complaint product, root cause cannot be determined due to insufficient information.If any additional information becomes available, then the complaint will be reopened and investigated thoroughly.Capa (if applicable): no corrective or preventive action required at this time.Multiple mdr reports were filed for this event, please see associated reports: 3002806535-2021-00100-1, 3002806535-2021-00102-1.If any further information is found which would change or alter any conclusions or information, a supplemental will be submitted accordingly.Zimmer biomet will continue to monitor for trends.H3 other text : item not returned to manufacturer.

• Brand Name: OXF UNI TIB TRAY SZ F RM PMA
• Common Device Name: KNEE ARTHROPLASTY
• Manufacturer (Section D): BIOMET UK LTD.; waterton industrial estates; bridgend CF31 3XA; UK CF31 3XA
• MDR Report Key: 11626201
• Report Number: 3002806535-2021-00101
• Device Sequence Number: 3546442
• Product Code: NRA
• UDI-Device Identifier: 05019279389162
• UDI-Public: 05019279389162
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: P010014
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Device Explanted Year: 2021
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 04/29/2021

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: 154776
• Device Lot Number: 579460
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 03/19/2021
• Supplement Date Received by Manufacturer: 04/21/2021
• Initial Report FDA Received Date: 04/07/2021
• Supplement Report FDA Received Date: 04/29/2021
• 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 Age: 60 YR