MAUDE Adverse Event Report: ZIMMER BIOMET, INC. HFN A/R SCREW 80MM; ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES

Catalog Number	814501080
Medical Device Problem Code	Migration or Expulsion of Device (1395)
Health Effect - Clinical Code	Discomfort (2330)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).D10: medical products: item#: 814510110, hfn lag screw 10.5mm x 110mm; lot#: tc1132310a; item#: 814503000, hfn end cap flush; lot#: td1113 b; item#: 814511180, hfn 130 deg 11mm x 180mm; lot#: 748660.G2: foreign: poland.H3: customer has indicated that the product is in process of being returned to zimmer biomet for investigation.Once the investigation has been completed, a follow-up mdr will be submitted.
Event or Problem Description
It was reported that the patient underwent an initial hip fracture surgery approximately seven (7) years ago, subsequently, the patient is able to palpate the lag screw through the skin and was causing the patient discomfort.The patient underwent a revision surgery on and unknown date and all implants were removed.
Event or Problem Description
No further event information available at the time of this report.
Additional Manufacturer Narrative
(b)(4).This follow-up report is being submitted to relay corrected information.The following sections were updated: b4; b5; d2; g2; g3; g6; h1; h2 upon receiving additional information of the reported event, it was determined that the product was not involved in the event.The initial report should be voided.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.

• Brand Name: HFN A/R SCREW 80MM
• Common Device Name: ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; p.o. box 587; warsaw IN 46581
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 56 e. bell drive; p.o. box 587; warsaw IN 46581
• Manufacturer Contact: jennifer rapsavage ; 56 e. bell dr.; warsaw, IN 46582 ; 5745260384
• MDR Report Key: 19070937
• Report Number: 0001825034-2024-00972
• Device Sequence Number: 15178591
• Product Code: HSB
• UDI-Device Identifier: 00887868038716
• UDI-Public: (01)00887868038716(17)260308(10)SP1122280F
• Combination Product (Y/N): N
• Initial Reporter Country: PL
• PMA/510(K) Number: K100238
• 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: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 08/06/2024

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 03/08/2026
• Device Catalogue Number: 814501080
• Device Lot Number: SP1122280F
• 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: 03/26/2024
• Supplement Date Received by Manufacturer: 07/24/2024
• Initial Report FDA Received Date: 04/09/2024
• Supplement Report FDA Received Date: 08/06/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 03/16/2016
• 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
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention; Hospitalization
• Patient Sex: Unknown