MAUDE Adverse Event Report: ZIMMER BIOMET, INC. ZIMMER SEGMENTAL FLUTED STRAIGHT STEM EXTENSION 9MM DIAMETER X 130MM LENGTH; PROSTHESIS, KNEE

Model Number	N/A
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Fall (1848); Bone Fracture(s) (1870)
Date of Event	06/13/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).D10 - concomitant devices - zimmer segmental distal femoral xt component size b left, catalog #: 00585004201, lot #: 64178798.Zimmer segmental segment with male/female taper 30mm length, catalog #: 00585004603, lot #: 65532610.Zimmer segmental stem collar 25mm, catalog #: 00585204025, lot #: 65530735.Zimmer segmental polyethylene insert xt size b, catalog #: 00585001296, lot #: 65885958.Zimmer segmental articular surface with segmental hinge post size b 12mm, catalog #: 00585002012, lot #: 64834863.Zimmer segmental precoat non-modular cemented tibial component size 3, catalog #: 00588000302, lot #: 65593919.Zimmer segmental trabecular metal medium tibial cone 31mm x 31mm, catalog #: 00545001331, lot #: 64882572.G2- report source - foreign: event occurred in australia.The complainant has indicated that the product will not be returned to zimmer biomet for investigation as the device was discarded.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 patient; please see all reports associated with this event: 0001822565-2023-02344, 0001822565-2023-02345, and 0001822565-2023-02346.H3 other text : investigation incomplete.
Event or Problem Description
It was reported that the patient underwent a left knee arthroplasty revision to address periprosthetic femur fracture after a fall approximately three (3) weeks post-operatively.Attempts have been made; however, no additional information is available.
Additional Manufacturer Narrative
This follow-up report is being submitted to relay additional information.H6 - component code - proposed code is mechanical (04) - stem.Visual evaluation of pictures provided identified that the femoral component had been removed with part of the femur bone still attached, confirming the reported fracture.The device history records were reviewed and no discrepancies were identified.A definitive root cause could not be determined with the information provided.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: ZIMMER SEGMENTAL FLUTED STRAIGHT STEM EXTENSION 9MM DIAMETER X 130MM LENGTH
• Common Device Name: PROSTHESIS, KNEE
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 1800 w. center st.; warsaw IN 46580
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 1800 w. center st.; warsaw IN 46580
• Manufacturer Contact: jennifer rapsavage ; 56 e. bell dr.; warsaw, IN 46582 ; 5745260384
• MDR Report Key: 17655556
• Report Number: 0001822565-2023-02347
• Device Sequence Number: 20415769
• Product Code: LZO
• UDI-Device Identifier: 00889024197701
• UDI-Public: (01)00889024197701(17)310606(10)65083867
• Combination Product (Y/N): N
• Initial Reporter Country: AS
• PMA/510(K) Number: K101296
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2023
• Device Explanted Year: 2023
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 01/23/2024

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 Model Number: N/A
• Device Catalogue Number: 00585205009
• Device Lot Number: 65083867
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/08/2023
• Supplement Date Received by Manufacturer: 01/18/2024
• Initial Report FDA Received Date: 08/30/2023
• Supplement Report FDA Received Date: 01/23/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 06/14/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• 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: Required Intervention; Hospitalization
• Patient Sex: Female