BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SMR REVERSE HUMERAL BODY

    MDR report key: 15650597 · Received October 21, 2022

    Report

    Report Number
    3008021110-2022-00088
    Event Type
    Injury
    Date Received
    October 21, 2022
    Date of Event
    March 26, 2021
    Report Date
    August 9, 2023
    Manufacturer
    LIMACORPORATE S.P.A.
    Product Code
    KWS
    PMA / PMN Number
    K110598
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 0

    THE STERILIZATION AND MANUFACTURING CHARTS OF THE INVOLVED DEVICES WERE CHECKED WITH THE FOLLOWING RESULTS: NO PRE-EXISTING ANOMALY ON THE 35 SMR CEMENTLESS FINNED STEM THAT BELONG TO PRODUCT CODE 1304.15.150, LOT 1921611, STERILIZATION 2000128. NO PRE-EXISTING ANOMALY ON THE 63 SMR REVERSE HUMERAL BODY THAT BELONG TO PRODUCT CODE 1352.15.010, LOT 2004535. NO PRE-EXISTING ANOMALY ON THE 58 SMR REVERSE LINER + 3 MM THAT BELONG TO PRODUCT CODE 1360.50.815, LOT 19AT3Y6, STERILIZATION 2000067. THEREFORE, WE CAN STATE THAT THE INVOLVED COMPONENTS WERE REGULARLY STERILIZED BEFORE BEING PLACED ON THE MARKET. WE WILL SUBMIT A FINAL REPORT AFTER THE CONCLUSION OF THE INVESTIGATION. ACCORDING TO THE FDA COMMUNICATION RECEIVED ON OCTOBER 13TH 2022 BY EMAIL, THIS REPORT WAS DELAYED DUE TO THE ENROLLMENT PROCESS.

    Additional Manufacturer Narrative · 0

    INVESTIGATION THE MANUFACTURING CHARTS OF THE INVOLVED DEVICES WERE CHECKED WITH THE FOLLOWING RESULTS: - NO PRE-EXISTING ANOMALY ON THE 35 SMR CEMENTLESS FINNED STEM THAT BELONG TO PRODUCT CODE 1304.15.150, LOT 1921611, STERILIZATION 2000128. - NO PRE-EXISTING ANOMALY ON THE 63 SMR REVERSE HUMERAL BODY THAT BELONG TO PRODUCT CODE 1352.15.010, LOT 2004535. - NO PRE-EXISTING ANOMALY ON THE 58 SMR REVERSE LINER + 3 MM THAT BELONG TO PRODUCT CODE 1360.50.815, LOT 19AT3Y6, STERILIZATION 2000067. THEREFORE, WE CAN STATE THAT THE INVOLVED COMPONENTS HAVE FOLLOWED THE REGULAR PROCEDURES BEFORE BEING PLACED ON THE MARKET. ACCORDING TO OUR INFORMATION: - AT LEAST 31 OUT OF 35 ITEMS BELONGING TO THE PRODUCT CODE 1304.15.150, LOT 1921611, STERILIZATION 2000128 HAVE BEEN IMPLANTED. - ALL THE 63 ITEMS BELONGING TO THE PRODUCT CODE 1352.15.010, LOT 2004535 HAVE BEEN IMPLANTED. - AT LEAST 54 OUT OF 58 ITEMS BELONGING TO THE PRODUCT CODE 1360.50.815, LOT 19AT3Y6, STERILIZATION 2000067 HAVE BEEN IMPLANTED. THIS IS THE FIRST AND ONLY COMPLAINT RECEIVED ON THESE LOT NUMBERS. EXPLANTS AND X-RAYS ANALYSIS: NO EXPLANT NOR X-RAYS WERE AVAILABLE TO BE ANALYSED, THEREFORE WE WERE NOT ABLE TO PERFORM ANY FURTHER INVESTIGATION. IN CONCLUSION, CONSIDERING THAT: - NO PRE-EXISTING ANOMALY WAS FOUND BY CHECKING THE MANUFACTURING CHARTS OF THE PRODUCTS BELONGING TO THE LOT NUMBERS INVOLVED. - NO FURTHER ANALYSIS CAN BE PERFORMED DUE TO THE UNAVAILABILITY OF THE EXPLANTS AND OF THE X-RAYS. WE CANNOT DETERMINE WITH CERTAINTY THE ROOT CAUSE OF THIS EVENT. NEVERTHELESS, WE CAN SUPPOSE THAT THE EVENT WAS NOT PRODUCT RELATED. PMS DATA: ACCORDING TO THE PMS DATA, THE REVISION RATE OF THE SMR REVERSE PROSTHESES DUE TO PAIN AND LOSS OF RANGE OF MOTION IS AROUND 0,03%. NO CORRECTIVE ACTIONS ARE REQUIRED FOR THIS SPECIFIC CASE. LIMACORPORATE WILL CONTINUE MONITORING THE MARKET TO PROMPTLY DETECT ANY FURTHER SIMILAR ISSUE. THIS IS A FINAL REPORT.

    Description of Event or Problem · 0

    REVISION SURGERY PERFORMED ON (B)(6) 2021, DUE TO PAIN AND LOSS OF RANGE OF MOTION. THE PATIENT HAS BEEN TREATED BY INFECTIOUS DISEASE AND WAS ON IV ANTIBIOTICS SEVERAL TIMES AND SUPPRESSIVE ORAL ANTIBIOTICS. THE SURGEON OPENED THE SHOULDER AND TOOK CULTURES TO RULE OUT INFECTION. THE LIMACORPORATE HUMERAL COMPONENT WAS REMOVED ENTIRELY. THE THIRD-PARTY GLENOID COMPONENT WAS ALSO REMOVED. EXTENSIVE IRRIGATION AND DEBRIDEMENT WERE THEN PERFORMED. COMPONENTS EXPLANTED: SMR CEMENTLESS FINNED STEM (PRODUCT CODE 1304.15.150, LOT 1921611, STERILIZATION 2000128). SMR REVERSE HUMERAL BODY (PRODUCT CODE 1352.15.010, LOT 2004535). SMR REVERSE LINER + 3 MM (PRODUCT CODE 1360.50.815, LOT 19AT3Y6, STERILIZATION 2000067). THE PATIENT WAS A FEMALE, 59 YEARS OLD. PATIENT'S SHOULDER CLINICAL HISTORY IS THE FOLLOWING: THE PRIMARY IMPLANT TOOK PLACE IN 2016 USING THIRD-PARTY COMPONENTS. THE IMPLANT USING COMPONENTS OF LIMACORPORATE WAS PERFORMED ON (B)(6) 2019. FIRST REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2019, DUE TO INFECTION, REGISTERED WITH THE INTERNAL COMPLAINT (B)(4) AND REPORTED WITH THE MFR 3008021110-2022-00086 SECOND REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2020, DUE TO INFECTION, REGISTERED WITH THE INTERNAL COMPLAINT (B)(4) AND REPORTED WITH THE MFR 3008021110-2022-00089. THIRD REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE (B)(6) 2020, DUE TO BRUISING AND ARM PAIN, REGISTERED WITH THE INTERNAL COMPLAINT (B)(4) AND REPORTED WITH THE MFR 3008021110-2022-00087 FOURTH REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2021, DUE TO PAIN AND LOSS OF RANGE OF MOTION (HEREBY REPORTED). FIFTH REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2021, DUE TO PAIN, REGISTERED WITH THE INTERNAL COMPLAINT (B)(4) AND REPORTED WITH THE MFR 3008021110-2022-00090. SIXTH REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2021, DUE TO BROKEN SCREW (NOT LIMACORPORATE) AND INFECTION, REGISTERED WITH THE INTERNAL COMPLAINT 244/22 AND REPORTED WITH THE MFR 3008021110-2022-00091.

    Description of Event or Problem · 0

    REVISION SURGERY PERFORMED ON (B)(6) 2021, DUE TO PAIN AND LOSS OF RANGE OF MOTION. THE PATIENT HAS BEEN TREATED BY INFECTIOUS DISEASE AND WAS ON IV ANTIBIOTICS SEVERAL TIMES AND SUPPRESSIVE ORAL ANTIBIOTICS. THE SURGEON OPENED THE SHOULDER AND TOOK CULTURES TO RULE OUT INFECTION. THE LIMACORPORATE HUMERAL COMPONENT WAS REMOVED ENTIRELY. THE THIRD-PARTY GLENOID COMPONENT WAS ALSO REMOVED. EXTENSIVE IRRIGATION AND DEBRIDEMENT WERE THEN PERFORMED. COMPONENTS EXPLANTED: - SMR CEMENTLESS FINNED STEM (PRODUCT CODE 1304.15.150, LOT 1921611, STERILIZATION 2000128). - SMR REVERSE HUMERAL BODY (PRODUCT CODE 1352.15.010, LOT 2004535). - SMR REVERSE LINER + 3 MM (PRODUCT CODE 1360.50.815, LOT 19AT3Y6, STERILIZATION 2000067). THE PATIENT WAS A FEMALE, 60 YEARS OLD. PATIENT'S SHOULDER CLINICAL HISTORY IS THE FOLLOWING: THE PRIMARY IMPLANT TOOK PLACE IN 2016 USING THIRD-PARTY COMPONENTS. THE IMPLANT USING COMPONENTS OF LIMACORPORATE WAS PERFORMED ON (B)(6) 2019. FIRST REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2019, DUE TO INFECTION, REGISTERED WITH THE INTERNAL COMPLAINT 239/22 AND REPORTED WITH THE MFR 3008021110-2022-00086. SECOND REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2020, DUE TO INFECTION, REGISTERED WITH THE INTERNAL COMPLAINT 242/22 AND REPORTED WITH THE MFR 3008021110-2022-00089. THIRD REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE (B)(6) 2020, DUE TO BRUISING AND ARM PAIN, REGISTERED WITH THE INTERNAL COMPLAINT 240/22 AND REPORTED WITH THE MFR 3008021110-2022-00087. FOURTH REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2021, DUE TO PAIN AND LOSS OF RANGE OF MOTION (HEREBY REPORTED). FIFTH REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2021, DUE TO PAIN, REGISTERED WITH THE INTERNAL COMPLAINT 243/22 AND REPORTED WITH THE MFR 3008021110-2022-00090. SIXTH REVISION SURGERY OF THE LIMA IMPLANT TOOK PLACE ON (B)(6) 2021, DUE TO BROKEN SCREW (NOT LIMACORPORATE) AND INFECTION, REGISTERED WITH THE INTERNAL COMPLAINT 244/22 AND REPORTED WITH THE MFR 3008021110-2022-00091. AFTER THE SIXTH REVISION SURGERY, THE PATIENT UNDERWENT A CUSTOM-MADE IMPLANT SURGERY, BUT AFTER THE SURGERY THE CUSTOM IMPLANT WAS FOUND LOOSE, AND THE SEVENTH REVISION SURGERY WILL BE PERFORMED. EVENT HAPPENED IN UNITED STATES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1927800 SMR REVERSE HUMERAL BODY SMR SHOULDER SYSTEM - REVERSE HUMERAL BODY FOR ELECTIVE SURGERY KWS LIMACORPORATE S.P.A. 1352.15.010 2004535

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown Required Intervention