FDA Adverse Event Injury Summary report: N

COMPREHENSIVE REVERSE SHOULDER GLENOSPHERE

MDR report key: 22664513 · Received July 30, 2025

Report

Report Number
0001825034-2025-02311
Event Type
Injury
Date Received
July 30, 2025
Date of Event
June 27, 2025
Report Date
September 19, 2025
Manufacturer
ZIMMER BIOMET, INC.
Product Code
PHX
UDI-DI
00880304475373
PMA / PMN Number
K193373
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). D10: ASSOCIATED PRODUCT INFORMATION, PART (LOT): 110031424(64862407). G2: FOREIGN: THE EVENT OCCURRED IN AUSTRALIA. THE CUSTOMER HAS INDICATED THAT THE PRODUCT WILL NOT BE RETURNED TO ZIMMER BIOMET FOR INVESTIGATION SINCE IT WAS NOT RETURNED BY THE HOSPITAL. THE INVESTIGATION IS IN PROCESS. ONCE THE INVESTIGATION HAS BEEN COMPLETED, A FOLLOW-UP MDR WILL BE SUBMITTED. IF ANY FURTHER INFORMATION IS FOUND THAT WOULD CHANGE OR ALTER ANY CONCLUSIONS OR INFORMATION, A SUPPLEMENTAL WILL BE FILED ACCORDINGLY. ZIMMER BIOMET WILL CONTINUE TO MONITOR FOR TRENDS.

Additional Manufacturer Narrative · 0

(B)(4). THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY ADDITIONAL INFORMATION. THE FOLLOWING SECTIONS WERE UPDATED/CORRECTED: B4; B5; D2; G1; G3; G6; H1; H2; H3; H6. D10: ASSOCIATED PRODUCT INFORMATION, PART (LOT): 010000589(161220). 110031402(64808960). 180552(60640). 113612(64877512). 180553(246180). 405889(834470). 110031424(64862407). 115395(105040). 405800(94530). 405883(923930). 180551(482110). THE REPORTED EVENT IS NOT CONFIRMED. NO PRODUCT WAS RETURNED OR PICTURES PROVIDED; VISUAL AND DIMENSIONAL EVALUATIONS COULD NOT BE PERFORMED. REVIEW OF THE DEVICE HISTORY RECORD(S) IDENTIFIED NO DEVIATIONS OR ANOMALIES DURING MANUFACTURING RELATED TO THE REPORTED EVENT. MEDICAL RECORDS WERE NOT PROVIDED. A DEFINITIVE ROOT CAUSE CANNOT BE DETERMINED. IF ANY FURTHER INFORMATION IS FOUND THAT WOULD CHANGE OR ALTER ANY CONCLUSIONS OR INFORMATION, A SUPPLEMENTAL WILL BE FILED ACCORDINGLY. ZIMMER BIOMET WILL CONTINUE TO MONITOR FOR TRENDS.

Description of Event or Problem · 0

IT WAS REPORTED A PATIENT HAD A PRIMARY SHOULDER ARTHROPLASTY. SUBSEQUENTLY, APPROXIMATELY 3 YEARS LATER, THE PATIENT UNDERWENT A REVISION PROCEDURE DUE TO A DISLOCATION. IT WAS REPORTED THAT NO FURTHER INFORMATION IS AVAILABLE.

Description of Event or Problem · 0

NO FURTHER EVENT INFORMATION IS AVAILABLE AT THE TIME OF THIS REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
45860 COMPREHENSIVE REVERSE SHOULDER GLENOSPHERE SHOULDER PROSTHESIS, REVERSE CONFIGURATION PHX ZIMMER BIOMET, INC. 927920 00880304475373

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Hospitalization| R SEE H11.| SEE H11.