BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GLENOID-DE PUY

    MDR report key: 173777 · Received June 15, 1998

    Report

    Report Number
    MW1014042
    Event Type
    Malfunction
    Date Received
    June 15, 1998
    Date of Event
    April 28, 1998
    Report Date
    June 11, 1998
    Manufacturer
    DEPUY, INC.
    Product Code
    KYM
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    SURFACE OF GLENOID FRAGMENTED. PT WITH PREVIOUS SHOULDER ARTHROPLASTY IN JAN 1996 FOR DEGENERATIVE JOINT DISEASE. EVIDENCE SUGGESTING UPWARD DISPLACEMENT OF HUMERAL HEAD RELATIVE TO GLENOID.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GLENOID-DE PUY Implant GLENOID COMPONENT KYM DEPUY, INC. PEGGED GLENOID *

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Other