FDA Adverse Event Injury Summary report: N

ANATOMIC SHOULDER PROSTHESIS

MDR report key: 24343897 · Received February 16, 2026

Report

Report Number
3005180920-2026-00100
Event Type
Injury
Date Received
February 16, 2026
Date of Event
December 30, 2025
Report Date
February 16, 2026
Manufacturer
MEDACTA INTERNATIONAL SA
Product Code
KWS
UDI-DI
07630040712620
PMA / PMN Number
K170910
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

BATCH REVIEW PERFORMED ON 28 JANUARY 2026 ANATOMICAL SHOULDER SYSTEM 04.01.0024 HUMERAL ANATOMICAL METAPHYSIS-CEMENTLESS-135& DEG; -7 (K170910) LOT 1910132: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 07-JUL-2020. EXPIRATION DATE: 21-JUN-2025. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. ANATOMICAL SHOULDER SYSTEM 04.01.0090 METAL HUMERAL HEAD D 40 (K170910) LOT 2301922: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 08-NOV-2023. EXPIRATION DATE: 22-OCT-2028. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. ANATOMICAL SHOULDER SYSTEM 04.01.0128 HC PEGGED GLENOID D 40 (K170910) LOT 2309355: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 22-SEP-2023. EXPIRATION DATE: 04-SEP-2028. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. ANATOMICAL SHOULDER SYSTEM 04.01.0180 SHORT HUMERAL DIAPHYSIS - CEMENTLESS - 7 (K180089) LOT 2335898: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 08-NOV-2023. EXPIRATION DATE: 15-OCT-2028. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. ROOT CAUSE: INFECTION IS A KNOWN POSSIBLE COMPLICATION OF ANY SURGERY. ALTHOUGH NO ROOT CAUSE CAN BE ESTABLISHED, THERE IS NO INDICATION THAT ANY ISSUE WITH THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT, AND THE DOCUMENT REVIEW DOES NOT INDICATE ANY POTENTIAL MANUFACTURING RELATED CAUSE.

Description of Event or Problem · 0

AT ABOUT 1 YEAR AND 6 MONTHS FROM THE PRIMARY, THE PATIENT CAME IN DUE TO SIGNS OF INFECTION AND THE CAUSE IS UNKNOWN. THE SURGEON REMOVED THE IMPLANTS AND PLACED AN ANTIBIOTIC SPACER. THE SURGERY WAS COMPLETED SUCCESSFULLY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
406277 ANATOMIC SHOULDER PROSTHESIS HUMERAL ANATOMICAL METAPHYSIS-CEMENTLESS-135°-7 KWS MEDACTA INTERNATIONAL SA 04.01.0024 1910132 07630040712620

Patients

Seq Age Sex Outcome Treatment
1 NA Female Required Intervention