MAUDE Adverse Event Report: ZIMMER BIOMET, INC. MODULAR NECK P 12/14 NECK TAPER USE WITH +0 HEADS ONLY; PROSTHESIS, HIP

Model Number	N/A
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Pain (1994)
Date of Event	08/16/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).Concomitant medical products: 00875705602 ¿ continuum shell ¿ 63102575; 00771301300 ¿ m/l taper stem ¿ 61468375; 00885201236 ¿ xlpe liner ¿ unknown lot; 00801803602 ¿ cocr head - 63197552.Visual examination of the provided pictures identified slight wear on the head and neck.The liner and shell are mated.Products are covered in bio-debris.Dhr was reviewed and no discrepancies were found.The root cause is unable to 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.Multiple mdr reports were filed for this event, please see associated reports: 0001822565 - 2021 -02581, 0001822565 - 2021 -02582, 0001822565 -2021 -02583, 0002648920 - 2021 -00262.
Event or Problem Description
It was reported that patient underwent a hip revision after an unknown amount of time post implantation due to pain.Attempts have been made and additional information on the reported event is unavailable at this time.

• Brand Name: MODULAR NECK P 12/14 NECK TAPER USE WITH +0 HEADS ONLY
• Common Device Name: PROSTHESIS, HIP
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• MDR Report Key: 12447987
• Report Number: 0001822565-2021-02580
• Device Sequence Number: 14331612
• Product Code: LPH
• UDI-Device Identifier: 00889024137820
• UDI-Public: (01)00889024137820(17)260131(10)63249095
• Combination Product (Y/N): N
• Initial Reporter State: AR
• Initial Reporter Country: US
• PMA/510(K) Number: K182678
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Explanted 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): 09/09/2021

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: 01/31/2026
• Device Model Number: N/A
• Device Catalogue Number: 00784801300
• Device Lot Number: 63249095
• 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: 08/16/2021
• Initial Report FDA Received Date: 09/09/2021
• 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