COMP RVRS SHLDR GLNSP +6 36MM
Report
- Report Number
- 0001825034-2021-02038
- Event Type
- Injury
- Date Received
- July 12, 2021
- Date of Event
- September 30, 2019
- Report Date
- May 31, 2022
- Manufacturer
- ZIMMER BIOMET, INC.
- Product Code
- KWS
- UDI-DI
- 00880304475786
- PMA / PMN Number
- K193373
- Removal / Correction Number
- N/A
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- AL, US
- Reporter Occupation
- 003
Narratives
(B)(4) THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2021-02039-2 0001825034-2021-02040-2 THE FOLLOWING SECTIONS WERE UPDATED: B4; B5; G3; G6; H1; H2 INVESTIGATION REMAINS UNCHANGED FROM THE PREVIOUS INVESTIGATION. ADDITIONAL LEGAL RECORDS WERE PROVIDED, HOWEVER, THE COMPLAINT CATEGORIES AND HARMS WERE ALREADY ACCOUNTED FOR PREVIOUSLY. 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.
(B)(4). THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2021-02039-3, 0001825034-2021-02040-3. D10: MEDICAL PRODUCTS: ITEM#: 113628, COMP PRIMARY STEM 8MM MINI; LOT#: 092560 ITEM#: 010000589, COMP RVRS 25MM BSPLT HA+ADPTR; LOT#: 147030 ITEM#: 115394, COMP RVS CNTRL 6.5X20MM ST/RST; LOT#: 225870, ITEM#: 180550, COMP LK SCR 3.5HEX 4.75X15 ST; LOT#: 361000, ITEM#: 180552, COMP LK SCR 3.5HEX 4.75X25 ST; LOT#: 236420, ITEM#: 180551, COMP LK SCR 3.5HEX 4.75X20 ST; LOT#: 795350, ITEM#: 180550, COMP LK SCR 3.5HEX 4.75X15 ST; LOT#: 361000, ITEM#: 118000, 25MM VERSA-DIAL TAPER ADAPTOR; LOT#: 139850, ITEM#: 110031400, MINI TRAY +5MM COCR +0 OFFSET; LOT#: 64345689, ITEM#: 110031420, CR PROLONG 36MM BRNG +3 RET; LOT#: 64291333. DURING THE INVESTIGATION PROCESS A REVIEW OF THE STERILE CERTIFICATIONS WERE REVIEWED AND FOUND TO BE CONFORMING WITH NO APPLICABLE DEVIATIONS. DEVICES WERE VERIFIED TO HAVE GONE THROUGH ACCEPTABLE STERILIZATION PROCESS FOLLOWING ISO/AAMI/ASTM & EU PUBLISHED GUIDELINES. THERE ARE MULTIPLE FACTORS THAT MAY CONTRIBUTE TO AN INFECTION THAT ARE OUTSIDE THE CONTROL OF ZIMMER BIOMET, SUCH AS EXTERNAL FACTORS, I.E. HOSPITAL/SURGICAL ENVIRONMENT, PROVIDER RELATED RISK FACTORS, AND/OR PATIENT COMORBIDITIES/RISK FACTORS. AS THERE ARE NO INDICATIONS OF A PRODUCT OR PROCESS ISSUES IDENTIFIED AFFECTING IMPLANT SAFETY OR EFFECTIVENESS, THEREFORE IMPLANTED PRODUCTS ARE NOT IDENTIFIED AS THE SOURCE OR CONTRIBUTING TO THE REPORTED INFECTION. 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.
(B)(4). THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2021-02039-1, 0001825034-2021-02040-1. 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.
NO FURTHER EVENT INFORMATION AVAILABLE AT THE TIME OF THIS REPORT.
NO FURTHER EVENT INFORMATION AVAILABLE AT THE TIME OF THIS REPORT.
IT WAS REPORTED THAT THE DURING I&D CULTURES PROCEDURE REVEALED THAT THE PATIENT WAS POSITIVE FOR ENTEROCOCUSS, FAECALIS, AND STAPHYLOCOCCUS EPIDERMIDIS SPECIES OF UNKNOWN SIGNIFICANCE. SUBSEQUENTLY, THE CARE OF THE PATIENT WAS TRANSFERRED TO AN INFECTIOUS DISEASE SPECIALIST APPROXIMATELY FOUR (4) WEEKS AFTER REVISION SURGERY. THE PATIENT WAS ALSO DIAGNOSED WITH A PROTHESIS JOINT INFECTION AT THAT TIME. THE PATIENT WAS UNDER THIS PHYSICIANS CARE FOR APPROXIMATELY ONE (1) YEAR AFTER THE REVISION SURGERY. THE PATIENT CONTINUES TO HAVE PAIN, DISCOMFORT AND LIMITED USE OF SHOULDER.
(B)(4). MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2021-02039, 0001825034-2021-02040. MEDICAL PRODUCTS: ITEM#: UNKNOWN, UNKNOWN HUMERAL BEARING; LOT#: UNKNOWN; ITEM#: UNKNOWN, UNKNOWN HUMERAL STEM; LOT#: UNKNOWN. NO PRODUCT WAS RETURNED OR PICTURES PROVIDED; VISUAL AND DIMENSIONAL EVALUATIONS COULD NOT BE PERFORMED. PART AND LOT IDENTIFICATION ARE NECESSARY FOR REVIEW OF DEVICE HISTORY RECORDS, NEITHER WERE PROVIDED. MEDICAL RECORDS WERE NOT PROVIDED. A DEFINITIVE ROOT CAUSE CANNOT 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.
IT WAS REPORTED THAT THE PATIENT UNDERWENT AN INITIAL SHOULDER ARTHROPLASTY APPROXIMATELY EIGHTEEN (18) YEARS AGO FOR UNKNOWN REASON. SUBSEQUENTLY, THE PATIENT WAS REVISED APPROXIMATELY TWO (2) YEARS AGO DUE TO PROXIMAL HUMOROUS FRACTURE. THE PATIENT UNDERWENT A SECOND REVISION APPROXIMATELY THREE (3) MONTHS AFTER FIRST REVISION DUE TO PROSTHESIS SUBLUXATION AND TUBEROSITY FRACTURE OF THEIR HUMERAL HEAD. APPROXIMATELY A MONTH AFTER SECOND REVISION THE PATIENT'S SHOULDER WAS INFECTED AND ANOTHER SURGICAL PROCEDURE WAS PERFORMED FOR THE INFECTION.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1052743 | COMP RVRS SHLDR GLNSP +6 36MM | SHOULDER PROSTHESIS, REVERSE CONFIGURATION/EXTREMITIES | KWS | ZIMMER BIOMET, INC. | N/A | 693520 | 00880304475786 |
| 1052744 | COMP RVRS SHLDR GLNSP +6 36MM | SHOULDER PROSTHESIS, REVERSE CONFIGURATION/EXTREMITIES | KWS | ZIMMER BIOMET, INC. | N/A | 693520 | 00880304475786 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Male | Hospitalization| R | SEE H10 FOR NARRATIVE| SEE H10 NARRATIVE |