FDA Adverse Event Injury Summary report: N

BONE SCREW Ø6,5 H.20MM

MDR report key: 12826680 · Received November 17, 2021

Report

Report Number
3008021110-2021-00088
Event Type
Injury
Date Received
November 17, 2021
Date of Event
November 8, 2021
Report Date
February 28, 2022
Manufacturer
LIMACORPORATE S.P.A.
Product Code
LPH
PMA / PMN Number
K172456
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

BY CHECKING THE STERILIZATION CHARTS OF THE INVOLVED LOT #S, NO PRE-EXISTING ANOMALY WAS FOUND ON THE OVERALL NUMBER. ALL THE PRODUCTS WITH THESE LOT #S HAVE BEEN PROPERLY STERILIZED BEFORE BEING PLACED ON THE MARKET. EXPLANTS ANALYSIS: ITEMS INVOLVED WERE NOT AVAILABLE TO BE RETURNED TO LIMACORPORATE FOR FURTHER ANALYSIS. X-RAYS ANALYSIS: LIMACORPORATE RECEIVED ONE X-RAY REFERRING TO PRE-OPERATIVE REVISION SURGERY. THE X-RAY RECEIVED - DATED (B)(6) 2021 - HAS BEEN EVALUATED BY A MEDICAL CONSULTANT. FOLLOWING, THE MEDICAL CONSULTANT COMMENTS: "AS FAR AS I CAN SEE THERE WAS A POSTOP INFECTION AND PARTIAL IMPLANT REMOVAL BEFORE THE INDEX OPERATION HERE. I DO NOT SEE ANY IMPLANT-RELATED PROBLEMS HERE". CONSIDERING THAT: · CHECK OF THE STERILIZATION CHARTS HIGHLIGHTED NO ANOMALIES ON THE COMPONENTS STERILIZED WITH THE INVOLVED LOT #S; · ACCORDING TO THE MEDICAL CONSULTANT, THERE WAS A POST-OP INFECTION AND NO IMPLANT-RELATED PROBLEMS; WE CAN STATE THAT THE EVENT WAS NOT PRODUCT RELATED. PMS DATA: ACCORDING TO LIMACORPORATE PMS DATA, REVISION RATE OF SMR REVERSE PROSTHESIS DUE TO INFECTION IS (B)(4). BASED ON THE ROOT CAUSE ANALYSIS PERFORMED AND ACCORDING TO THE RELEVANT PMS DATA, NO CORRECTIVE ACTIONS REQUIRED FOR THIS SPECIFIC CASE. LIMACORPORATE WILL CONTINUE MONITORING THE MARKET TO PROMPTLY DETECT ANY FURTHER SIMILAR ISSUE. NOTE: THIS IS A FINAL MDR.

Additional Manufacturer Narrative · 0

BY CHECKING THE DHR OF THE INVOLVED LOT #1901275, LOT #1902795 AND LOT #1903156 NO PRE-EXISTING ANOMALY WAS FOUND ON THE ITEMS PLACED ON THE MARKET WITH THE SAME LOT #S. THIS IS THE FIRST AND ONLY COMPLAINT RECEIVED ON THESE LOT #S. WE WILL SUBMIT A FINAL MDR AS SOON AS THE INVESTIGATION WILL BE COMPLETED.

Description of Event or Problem · 0

SHOULDER REVISION SURGERY OF A SMR REVERSE IMPLANT PERFORMED ON (B)(6), 2021, DUE TO INFECTION, RESULTING IN IMPLANT LOOSENING. IT WAS REPORTED THAT THE FOLLOWING COMPONENTS WERE REMOVED: · SMR UNCEMENTED GLENOID #SMALL-R (PRODUCT CODE 1375.20.005, LOT #1901275 - STER. 1900092) - PRODUCT NOT SOLD IN THE US. · BONE SCREW Ø6,5 H.20MM (PRODUCT CODE 8420.15.010, LOT #1902795 - STER. 1900086). · BONE SCREW Ø6,5 H.30MM (PRODUCT CODE 8420.15.030, LOT #1903156 - STER. 1900099). A COMPETITOR'S PROSTHESIS WAS IMPLANTED. ACCORDING TO THE COMPLAINT SOURCE, SWABS WERE TAKEN, HOWEVER THE RESULTS ARE NOT AVAILABLE. BASED ON THE PROVIDED INFORMATION, PATIENT' HISTORY IS THE FOLLOWING: - PRIMARY SURGERY PERFORMED ON (B)(6), 2019. SMR REVERSE PROSTHESIS IMPLANTED; - FIRST REVISION SURGERY TOOK PLACE ON (B)(6), 2019, DUE TO DISLOCATION. THE COMPLAINT WAS REGISTERED AS LIMACORPORATE #(B)(4). PATIENT WAS NON COMPLAINT TO POST SURGERY RECOMMENDATIONS; - SECOND REVISION SURGERY PERFORMED ON (B)(6), 2020, DUE TO INSTABILITY AND INFECTION. NO FURTHER DETAILS AVAILABLE. PATIENT IS A FEMALE, 61 YEARS OLD. ACCORDING TO THE REPORTED INFORMATION, PATIENT HAS A MODERATE BMI, AND PERFORMS LOW PHYSICAL ACTIVITY LEVEL. EVENT HAPPENED IN AUSTRALIA.

Description of Event or Problem · 0

SHOULDER REVISION SURGERY OF A SMR REVERSE IMPLANT PERFORMED ON (B)(6) 2021, DUE TO INFECTION RESULTING IN IMPLANT LOOSENING. IT WAS REPORTED THAT THE FOLLOWING COMPONENTS WERE REMOVED: SMR UNCEMENTED GLENOID #SMALL-R (PRODUCT CODE 1375.20.005, LOT #1901275 - STER. 1900092) - PRODUCT NOT SOLD IN THE US. BONE SCREW Ø6,5 H.20MM (PRODUCT CODE 8420.15.010, LOT #1902795 - STER. 1900086). BONE SCREW Ø6,5 H.30MM (PRODUCT CODE 8420.15.030, LOT #1903156 - STER. 1900099). A COMPETITOR'S PROSTHESIS WAS IMPLANTED. ACCORDING TO THE COMPLAINT SOURCE, SWABS WERE TAKEN, HOWEVER THE RESULTS ARE NOT KNOWN YET. BASED ON THE PROVIDED INFORMATION, PATIENT' HISTORY IS THE FOLLOWING: PRIMARY SURGERY PERFORMED ON (B)(6) 2019. SMR REVERSE PROSTHESIS IMPLANTED; FIRST REVISION SURGERY TOOK PLACE ON (B)(6) 2019, DUE TO DISLOCATION. THE COMPLAINT WAS REGISTERED AS LIMACORPORATE #(B)(4). PATIENT WAS NON COMPLAINT TO POST SURGERY RECOMMENDATIONS; SECOND REVISION SURGERY PERFORMED ON (B)(6) 2020, DUE TO INSTABILITY AND INFECTION. NO FURTHER DETAILS AVAILABLE. PATIENT IS A FEMALE, (B)(6). ACCORDING TO THE REPORTED INFORMATION, PATIENT HAS A MODERATE BMI, AND LOW PHYSICAL ACTIVITY LEVEL. EVENT HAPPENED IN (B)(6).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1730706 BONE SCREW Ø6,5 H.20MM BONE SCREWS DIA. 6.5 X H. 20 MM LPH LIMACORPORATE S.P.A. 8420.15.010 1902795

Patients

Seq Age Sex Outcome Treatment
1 Unknown Required Intervention