MAUDE Adverse Event Report: ZIMMER MANUFACTURING B.V. VERSYS FEMORAL STEM CEMENTED REVISION/CALCAR 12/14 NECK TAPER SIZE 19 200 MM; PROSTHESIS, HIP

Catalog Number	00787101960
Medical Device Problem Code	Tear, Rip or Hole in Device Packaging (2385)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/09/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).D10: 00787101760 item name femoral stem cemented revision/calcar 12/14 neck taper size 17 190 mm stem length for cemented use only lot # 65521330.G2: foreign: canada visual evaluation of the provided photos and the returned product found the outer carton exhibits crush damage.Additionally, the stem has punctured all sterile barriers.The sterility is considered breached.Review of the device history records identified no deviations or anomalies during manufacturing.Medical records were not provided.The condition of the device when it left zimmer biomet control is considered conforming to specification.The root cause of the reported event can be attributed to transit damage.This complaint was confirmed by evaluation of the provided photos and returned product.This report was previously reported under mfr 0001822565-2024-03437 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
It was reported that the 17 and 19 femoral stems had broken through the box.The procedure was completed using a size 15 implant.There is no additional information available at the time of this report.

• Brand Name: VERSYS FEMORAL STEM CEMENTED REVISION/CALCAR 12/14 NECK TAPER SIZE 19 200 MM
• Common Device Name: PROSTHESIS, HIP
• Manufacturer (Section D): ZIMMER MANUFACTURING B.V.; turpeaux industrial park; route #1 km 123.4 bldg #1; mercedita PR 00715
• Manufacturer (Section G): ZIMMER MANUFACTURING B.V.; turpeaux industrial park; route #1 km 123.4 bldg #1; mercedita PR 00715
• Manufacturer Contact: jennifer rapsavage ; 56 e. bell dr.; warsaw, IN 46582 ; 5745260384
• MDR Report Key: 21514260
• Report Number: 0002648920-2025-00060
• Device Sequence Number: 18136096
• Product Code: JDI
• UDI-Device Identifier: 00889024140127
• UDI-Public: (01)00889024140127(17)260831(10)63416364
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K210842
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 10/29/2024

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
• Device Expiration Date: 08/31/2026
• Device Catalogue Number: 00787101960
• Device Lot Number: 63416364
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/11/2024
• 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: 02/27/2025
• Initial Report FDA Received Date: 03/04/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 08/29/2016
• 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
• Patient Sex: Prefer Not To Disclose