MAUDE Adverse Event Report: ZIMMER BIOMET, INC. LINER 22 MM I.D. FOR USE WITH 42/43 MM O.D. SHELLS; PROSTHETIC, HIP

Model Number	N/A
Medical Device Problem Code	Packaging Problem (3007)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/21/2023
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the shipment was received with a hair in the box.There was no patient involvement reported.There is no additional information available at the time of this report.
Additional Manufacturer Narrative
(b)(4).G2: foreign: thailand.The product has been received by zimmer biomet.The investigation is currently in process.Once the investigation has been completed, a follow-up report will be submitted.
Event or Problem Description
Upon reassessment of the reported event, it was determined to be not reportable.The debris were found on the outside of the packaging therefore sterility was no compromised.The initial report was forwarded in error.
Additional Manufacturer Narrative
Upon reassessment of the reported event, it was determined to be not reportable.The debris were found on the outside of the packaging therefore sterility was no compromised.The initial report was forwarded in error.

• Brand Name: LINER 22 MM I.D. FOR USE WITH 42/43 MM O.D. SHELLS
• Common Device Name: PROSTHETIC, HIP
• 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: 17739743
• Report Number: 0001822565-2023-02493
• Device Sequence Number: 14832542
• Product Code: KWY
• UDI-Device Identifier: 00889024633216
• UDI-Public: (01)00889024633216(17)271228(10)65745156
• Combination Product (Y/N): N
• Initial Reporter Country: TH
• PMA/510(K) Number: K833991
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/20/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: N/A
• Device Catalogue Number: 00500104222
• Device Lot Number: 65745156
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/05/2023
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/21/2023
• Supplement Date Received by Manufacturer: 11/17/2023
• Initial Report FDA Received Date: 09/13/2023
• Supplement Report FDA Received Date: 11/21/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 12/29/2022
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• 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
• Patient Sex: Unknown