BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BASE PLATE UNCEMENTED 20 MM POST LENGTH

    MDR report key: 16959211 · Received May 18, 2023

    Report

    Report Number
    0001822565-2023-01188
    Event Type
    Injury
    Date Received
    May 18, 2023
    Date of Event
    December 23, 2022
    Report Date
    May 11, 2023
    Manufacturer
    ZIMMER BIOMET, INC.
    Product Code
    PHX
    UDI-DI
    00889024489448
    PMA / PMN Number
    K172767
    Removal / Correction Number
    NI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    (B)(4). THIS WAS INITIALLY REPORTED ON 0001822565-2023-00148; HOWEVER, PRODUCT ID NEEDED TO BE UPDATED BASED ON ADDITIONAL INFORMATION RECEIVED. NO PRODUCT WAS RETURNED OR PICTURES PROVIDED; VISUAL AND DIMENSIONAL EVALUATIONS COULD NOT BE PERFORMED. RADIOGRAPHS WERE PROVIDED AND REVIEWED BY A HEALTH CARE PROFESSIONAL. REVIEW OF THE AVAILABLE RECORDS IDENTIFIED THE FOLLOWING: RELATIVE RADIOLUCENCY OF THE GLENOID SUGGESTS SEVERE OSTEOPENIA. HOWEVER, NO DEFINITE FRACTURE CAN BE SEEN. REVIEW OF THE DEVICE HISTORY RECORD(S) IDENTIFIED NO DEVIATIONS OR ANOMALIES DURING MANUFACTURING. A DEFINITIVE ROOT CAUSE CANNOT BE DETERMINED. IF ANY FURTHER INFORMATION WHICH WOULD CHANGE OR ALTER ANY CONCLUSIONS OR INFORMATION, A SUPPLEMENTAL REPORT WILL BE FILED ACCORDINGLY. ZIMMER BIOMET WILL CONTINUE TO MONITOR FOR TRENDS. ASSOCIATED PRODUCTS AND REPORTS: 0001822565-2023-00148-1; ITEM#00434901213; LOT#65538166. 0001822565-2023-00149-1; ITEM#00-4360-036-00; LOT#65356130. 0001822565-2023-00152; ITEM#00434903603; LOT#65352850. OTHER ASSOCIATED PRODUCTS: ITEM#47436108300; LOT#56672638. ITEM#0104223033; LOT#3021582. ITEM#0104223042; LOT#3127010. ITEM#47430906125; LOT#65267726. ITEM#47430904601; LOT#65157507. ITEM#47430902501; LOT#65553821.

    Description of Event or Problem · 0

    IT WAS REPORTED PATIENT UNDERWENT A RIGHT SHOULDER REVISION APPROXIMATELY TWO (2) WEEKS POST IMPLANTATION DUE POOR BONE QUALITY, DISLOCATION, AND FIXATION OF IMPLANT. ATTEMPTS HAVE BEEN MADE AND NO FURTHER INFORMATION HAS BEEN PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    643592 BASE PLATE UNCEMENTED 20 MM POST LENGTH SHOULDER PROSTHESIS, REVERSE CONFIGURATION PHX ZIMMER BIOMET, INC. NI 64390359 00889024489448

    Patients

    Seq Age Sex Outcome Treatment
    1 Female Required Intervention| H