Brand Name | 32MM M2A MOD HEAD -6MM NK |
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 | 14052397 |
MDR Text Key | 288865164 |
Report Number | 0001825034-2022-00852 |
Device Sequence Number | 1 |
Product Code |
KWA
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K042841 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Consumer |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial |
Report Date |
04/07/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 04/08/2022 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 04/30/2011 |
Device Model Number | N/A |
Device Catalogue Number | 11-163667 |
Device Lot Number | 322680 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 03/21/2022 |
Was the Report Sent to FDA? |
No
|
Date Manufacturer Received | 03/18/2022 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 04/30/2001 |
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 Sequence Number | 1 |
Treatment | UNK CUP; UNK STEM |
Patient Outcome(s) |
Hospitalization;
Required Intervention;
|