MAUDE Adverse Event Report: ZIMMER MANUFACTURING B.V. ALL POLY PATELLA CEMENTED 35 MM DIAMETER; PROSTHESIS, KNEE

Model Number	N/A
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Pain (1994); Ambulation or Postural Difficulties (2544)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).Associated products : item#: 42502606401; femur cemented (cr) standard left size 8; lot#: 63590447; item#: 42532007501; tibia cemented 5 degree stemmed left size f; lot#: 63722196; item#: 42557000114; stem extension tapered cemented 14 mm +30 mm; lot#: 62682267; item#: 42512100810; articular surface (mc) left 10 mm ; lot#: 63667620.Customer has indicated that the product will not be returned to zimmer biomet for investigation, as it is still implanted.The investigation is in process.Once the investigation has been completed, a follow-up mdr will be submitted.Multiple mdr reports were filed for this event, please see associated reports: 3007963827 - 2021 - 00122, 3007963827 - 2021 - 00123, 0001822565 - 2021 - 01472 , 0001822565 - 2021 - 01473.
Event or Problem Description
It was reported patient underwent a left knee procedure approximately 3.5 years ago.Subsequently, patient suffers from pain and possible allergic reaction.Patient reports he will be undergoing additional testing for cobalt poisoning.Additionally, patient has been to the hospital twice to remove 60cc of blood.Patient experiences increased pain when working out, and does not have full range of motion as he cannot kneel and has to use a cane or wheelchair often.
Additional Manufacturer Narrative
This follow-up report is being submitted to relay additional information.The following sections were updated: b4; b5; e1; e2; e3; g3; g6; h1; h2; h3; h6.Reported event was unable to be confirmed due to limited information received from the customer.No product was returned or pictures provided; visual and dimensional evaluations could not be performed.Device history record (dhr) review identified no deviations or anomalies during manufacturing, related to the reported event.A definitive root cause cannot be determined.Per package insert, pain and poor range motion are known adverse effects of the system.If any further information is found which would change or alter any conclusions or information, a supplemental report will be filed accordingly.Zimmer biomet will continue to monitor for trends.
Event or Problem Description
No further event information available at the time of this report.

• Brand Name: ALL POLY PATELLA CEMENTED 35 MM DIAMETER
• Common Device Name: PROSTHESIS, KNEE
• Manufacturer (Section D): ZIMMER MANUFACTURING B.V.; turpeaux industrial park; route #1 km 123.4 bldg #1; mercedita PR 00715
• MDR Report Key: 11912826
• Report Number: 0002648920-2021-00140
• Device Sequence Number: 4365184
• Product Code: JWH
• UDI-Device Identifier: 00889024247642
• UDI-Public: (01)00889024247642(17)250531(10)63695643
• Combination Product (Y/N): N
• Initial Reporter State: AZ
• Initial Reporter Country: US
• PMA/510(K) Number: K113369
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: consumer
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 09/28/2021

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 Expiration Date: 05/31/2025
• Device Model Number: N/A
• Device Catalogue Number: 42540000035
• Device Lot Number: 63695643
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 05/04/2021
• Supplement Date Received by Manufacturer: 09/27/2021
• Initial Report FDA Received Date: 06/01/2021
• Supplement Report FDA Received Date: 09/29/2021
• 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
• Concomitant Medical Products and Therapy/Usage Dates: SEE H10
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Weight: 104