MAUDE Adverse Event Report: ZIMMER BIOMET, INC. G7 ACETABULAR SYSTEM OSSEOTI; PROSTHESIS, HIP

Model Number	110010263
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Bone Fracture(s) (1870)
Date of Event	09/05/2024
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that approximately five days post-implantation, the patient underwent a hip revision due to a fracture.Patient had a proximal femur replacement and pelvic fixation.Attempts have been made and no further information has been provided.
Additional Manufacturer Narrative
(b)(4).D10: cat# 802403602, lot# 3018283, constrained head 12/14 taper 36 mm diameter -3 mm neck length; cat# 00585204025, lot# 66466706, stem collar 25 mm o.D.; cat# 00585205011, lot# 66723558, fluted stem extension straight precoat 11 mm diameter 130 mm length; cat# 00585003238, lot# 66552379, proximal femoral component 38 mm offset; cat# 010000982, lot# 7707595, g7 freedom const e1 lnr 36mm d; cat# 66022663, lot# 68641379, palacos r + g (1x40); cat# 3020830401-3, lot# ax47ck0804, refobacin plus bone cem 40 -3.G2: foreign ¿ australia.The customer has indicated that the product will not be returned to zimmer biomet for investigation, as its location is unknown.The investigation is in process.Once the investigation has been completed, a follow-up mdr will be submitted.
Event or Problem Description
It was determined this product should not have been reported under this mfr number.This report should be voided and a corrected report will be filed under mfr number (1825034).
Additional Manufacturer Narrative
It was determined this product should not have been reported under this mfr number.This report should be voided and a corrected report will be filed under mfr number (1825034).

• Brand Name: G7 ACETABULAR SYSTEM OSSEOTI
• Common Device Name: PROSTHESIS, 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: 20359295
• Report Number: 0001822565-2024-03173
• Device Sequence Number: 8086401
• Product Code: LPH
• UDI-Device Identifier: 00887868356018
• UDI-Public: (01)00887868356018(17)330921(10)65960971
• Combination Product (Y/N): N
• Initial Reporter Country: AS
• PMA/510(K) Number: K140669
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Device Explanted Year: 2024
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Distributor
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 10/08/2024

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: 110010263
• Device Lot Number: 65960971
• 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: 09/07/2024
• Supplement Date Received by Manufacturer: 10/02/2024
• Initial Report FDA Received Date: 10/03/2024
• Supplement Report FDA Received Date: 10/08/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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
• Concomitant Medical Products and Therapy/Usage Dates: SEE H11 NARRATIVE.
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 6 MO
• Patient Sex: Female