MAUDE Adverse Event Report: ZIMMER BIOMET, INC. EPOLY 36MM +5 RGLC LNR HW SZ23 Z23 PROSTHESIS, HIP

Model Number N/A

Device Problems Fracture (1260); Device Dislodged or Dislocated (2923)

Patient Problems Joint Dislocation (2374); No Code Available (3191)

Event Date 01/10/2020

Event Type  Injury  

Manufacturer Narrative

(b)(4). Concomitant medical products: catalog#: 11-363664 36mm cocr mod hd +6mm lot#: 271810, catalog#: ni ringloc cup 58mm finned lot#: 450080. Report source: foreign: (b)(6). 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. Multiple mdr reports were filed for this event, please see associated reports: 0001825034-2020-00405.

Event Description

It was reported that the patient underwent a revision procedure due to dislocation and fracture of the liner. Attempts have been made and additional information on the reported event is unavailable at this time.

Event Description

No further event information available at the time of this report.

Manufacturer Narrative

The event was confirmed with product received. Upon visual inspection the head has some scuffing on the outer radius. The liner is impacted into the cup and cannot be removed. The wall of the liner had fractured into a separate piece that was also returned and the visible scallops show damage. Device history record review was unable to be performed as the lot number of the device involved in the event is unknown. Root cause was unable to be determined. 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: EPOLY 36MM +5 RGLC LNR HW SZ23 Z23
• Type of Device: PROSTHESIS, HIP
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• MDR Report Key: 9632687
• Report Number: 0001825034-2020-00404
• Device Sequence Number: 1
• Product Code: OIY
• Combination Product (y/n): N
• PMA/PMN Number: K100048
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor,foreign,health pr
• Type of Report: Initial,Followup
• Report Date: 05/08/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/27/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes

Device Operator

• Device Model Number: N/A
• Device Catalogue Number: EP-105790
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/21/2020
• Was the Report Sent to FDA?: No
• Event Location: No Information
• Date Manufacturer Received: 05/05/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Removal/Correction Number: N/A
• Patient Outcome(s): Hospitalization; Required Intervention