MAUDE Adverse Event Report: ZIMMER BIOMET, INC. M2A-MAGNUM PF CUP 62ODX56ID PROSTHESIS, HIP

Model Number N/A

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Wound Dehiscence (1154)

Event Date 12/15/2020

Event Type  Injury  

Manufacturer Narrative

(b)(4). Catalog number: 192411 lot number:219480 brand name: (b)(4). Catalog number:us157862 lot number:315260 brand name: (b)(4). Catalog number:650-1065 lot number:unknown brand name: (b)(4). Catalog number:110031006 lot number:unknown brand name: (b)(4). Catalog number:650-1055 lot number:unknown brand name: (b)(4). Multiple reports were submitted along with this report: 0001825034-2022-00607. Customer has indicated that the product will not be returned to zimmer biomet for investigation. The investigation is in process. Once the investigation has been completed, a follow-up mdr will be submitted.

Event Description

It was reported that the patient was revised due to wound dehiscence and deep hip seroma with swelling and serosanguineous fluid approximately 2 weeks post revision surgery. During the revision tissue sent for cultures, results pending, and debridement of adhesions. Wound vac placed and iv antibiotics until culture is negative. Stopped dvt anticoagulants due to wound complications. Attempts have been made and additional information on the reported event is unavailable at this time.

• Brand Name: M2A-MAGNUM PF CUP 62ODX56ID
• Type of Device: PROSTHESIS, HIP
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• Manufacturer Contact: christina arnt ; 56 e. bell dr.; warsaw, IN 46582 ; 5745273773
• MDR Report Key: 13826339
• MDR Text Key: 287695213
• Report Number: 0001825034-2022-00608
• Device Sequence Number: 1
• Product Code: KWY
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K101336
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Consumer,Health Professional,Company Representative

Reporter Occupation

• Type of Report: Initial,Followup
• Report Date: 05/18/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/19/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No

Device Operator

• Device Expiration Date: 02/28/2021
• Device Model Number: N/A
• Device Catalogue Number: US157862
• Device Lot Number: 315260
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 05/03/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 02/01/2011
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Removal/Correction Number: N/A

Patient Treatment Data

Date Received: 03/19/2022 Patient Sequence Number: 1