ANATOMIC SHOULDER PROSTHESIS
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
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.
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 |