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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ZIMMER BIOMET, INC. E-POLY 40MM +3 HIWALL LNR SZ25 PROSTHESIS, HIP

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ZIMMER BIOMET, INC. E-POLY 40MM +3 HIWALL LNR SZ25 PROSTHESIS, HIP Back to Search Results
Catalog Number EP-108525
Device Problem Insufficient Information (3190)
Patient Problem No Information (3190)
Event Date 02/20/2015
Event Type  Injury  
Manufacturer Narrative
(b)(4). Concomitant medical products: pt-106062-regen/rnglc+ multi-253460, s991140-selex/magnum mod-688000, 103534-ti low profile screw-155530, 103533-ti low profile screw-155480. Multiple mdr reports were filed for this event, please see associated reports: 0001825034 - 2019 - 05126, 0001825034 - 2019 - 05129. Customer has indicated that the product will not be returned to zimmer biomet for investigation, product location unknown. The investigation is in process. Once the investigation has been completed, a follow-up mdr will be submitted. Product location unknown.
 
Event Description
It was reported the patient underwent an initial hip arthroplasty. Subsequently, the patient underwent an acetabular revision due to unknown reasons a little over two years later. Attempts have been made and additional information on the reported event is unavailable at this time.
 
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Brand NameE-POLY 40MM +3 HIWALL LNR SZ25
Type of DevicePROSTHESIS, HIP
Manufacturer (Section D)
ZIMMER BIOMET, INC.
56 e. bell drive
warsaw IN 46582
Manufacturer (Section G)
ZIMMER BIOMET, INC.
56 e. bell drive
warsaw IN 46582
Manufacturer Contact
christina arnt
56 e. bell dr.
warsaw, IN 46582
5745273773
MDR Report Key9321261
MDR Text Key168057633
Report Number0001825034-2019-05127
Device Sequence Number1
Product Code OIY
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K100048
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type distributor,health profession
Reporter Occupation
Type of Report Initial,Followup
Report Date 02/27/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received11/14/2019
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator
Device Expiration Date02/28/2018
Device Catalogue NumberEP-108525
Device Lot Number619190
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA? No
Event Location No Information
Date Manufacturer Received02/27/2020
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured02/01/2013
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Removal/Correction NumberN/A

Patient Treatment Data
Date Received: 11/14/2019 Patient Sequence Number: 1
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