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

Model Number	N/A
Medical Device Problem Codes	Corroded (1131); Material Erosion (1214)
Health Effect - Clinical Codes	Inflammation (1932); Necrosis (1971); Pain (1994); Scar Tissue (2060); Metal Related Pathology (4530)
Date of Event	07/14/2021
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).Concomitant medical products: ref: (b)(4), lot 63165360, zimmer tm shell ref: (b)(4), lot: 63446114, zimmer longevity liner.Ref: (b)(4), lot: 63410020, zimmer screw.Ref: 00771300600, lot: 63206750, zimmer m/l stem.The device will not be returned for analysis, due to location of device is unknown; however, an investigation of the reported event is in progress.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: 0002648920 -2021-00328.
Event or Problem Description
It was reported that the patient underwent initial right total hip arthroplasty.Subsequently, the patient was revised approximately 5 years later due to pain and trunnionosis at the head/neck junction.The postop pathology report noted dense fibrosis, necrotic tissue, and inflammation.The head and neck components were replaced.Attempts have been made and additional information on the reported event is unavailable at this time.
Additional Manufacturer Narrative
This follow-up report is being submitted to relay additional information.No product was returned or pictures provided; visual and dimensional evaluations could not be performed.Medical records were provided and reviewed by a health care professional.Review of the available records identified the following: the patient was revised due to pain and trunnionosis.Previous exams leading up to the revision show joint effusion and mild edema.A work done was negative for infection.No corrosion was noted at the stem- neck junction, but mild trunnionosis was found at the head-neck junction.The stem and liner were both in excellent condition and well fixed.The head and neck were exchanged.Review of the device history records identified no deviations or anomalies during manufacturing.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
No further event information available at the time of this report.

• Brand Name: MODULAR NECK K 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: 12592626
• Report Number: 0001822565-2021-02924
• Device Sequence Number: 4459945
• Product Code: LPH
• UDI-Device Identifier: 00889024137745
• UDI-Public: (01)00889024137745(17)260531(10)63362407
• Combination Product (Y/N): N
• Initial Reporter State: NV
• Initial Reporter Country: US
• PMA/510(K) Number: K063251
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2016
• Device Explanted Year: 2021
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: consumer,health professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 10/13/2021

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 05/31/2026
• Device Model Number: N/A
• Device Catalogue Number: 00784800200
• Device Lot Number: 63362407
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 09/16/2021
• Supplement Date Received by Manufacturer: 10/12/2021
• Initial Report FDA Received Date: 10/07/2021
• Supplement Report FDA Received Date: 10/13/2021
• 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 NARRATIVE.
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention