BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DXTEND SCREW NO LOCK D4.5X18MM

    MDR report key: 25033955 · Received April 29, 2026

    Report

    Report Number
    1818910-2026-07853
    Event Type
    Injury
    Date Received
    April 29, 2026
    Manufacturer
    DEPUY ORTHOPAEDICS INC US
    Product Code
    HSD
    UDI-DI
    10603295027782
    PMA / PMN Number
    K192855
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    PRODUCT COMPLAINT # (B)(4) THIS REPORT IS BEING SUBMITTED PURSUANT TO THE PROVISIONS OF 21 CFR, PART 803 (AND/OR PART 4, AS APPLICABLE). THIS REPORT MAY BE BASED ON INFORMATION WHICH HAS NOT BEEN INVESTIGATED OR VERIFIED PRIOR TO THE REQUIRED REPORTING DATE. THIS REPORT DOES NOT REFLECT A CONCLUSION BY DEPUY SYNTHES, OR ITS EMPLOYEES THAT THE REPORT CONSTITUTES AN ADMISSION THAT THE PRODUCT, DEPUY SYNTHES, OR ITS EMPLOYEES CAUSED OR CONTRIBUTED TO THE POTENTIAL EVENT DESCRIBED IN THIS REPORT. IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL REPORT, A FOLLOW-UP REPORT WILL BE FILED AS APPROPRIATE. H11 ADDITIONAL NARRATIVE: A1:(B)(4).

    Additional Manufacturer Narrative · 0

    PRODUCT COMPLAINT: (B)(4). INVESTIGATION SUMMARY: NO DEVICE ASSOCIATED WITH THIS REPORT WAS RECEIVED FOR EXAMINATION. THE PRODUCT INVESTIGATION FOUND NO EVIDENCE SUSPECTING AN ERROR IN THE MANUFACTURING OR MATERIAL THAT WOULD BE A CONTRIBUTING FACTOR IN THE REPORTED ALLEGATION(S). A RECORDS EVALUATION (MRE) WAS NOT PERFORM. AS PART OF OUR COMPANY QUALITY SYSTEM PROCESS, ALL DEVICES ARE MANUFACTURED, INSPECTED, AND DISTRIBUTED TO APPROVED SPECIFICATIONS. ADDITIONAL COMPLAINT INFORMATION MONITORING FOR POTENTIAL SAFETY SIGNALS WILL BE CONDUCTED THROUGH COMPLAINT TRENDING AS PART OF THE POST-MARKET SURVEILLANCE. IF ADDITIONAL INFORMATION IS MADE AVAILABLE, THE INVESTIGATION WILL BE UPDATED AS APPLICABLE. DEVICE HISTORY LOT: THERE IS NO EVIDENCE SUSPECTING AN ERROR IN THE MANUFACTURING OR MATERIAL THAT WOULD BE A CONTRIBUTING FACTOR IN THE REPORTED ALLEGATION(S). A MANUFACTURING RECORDS EVALUATION (MRE) WAS NOT PERFORMED. ADDED: D1, D10 (CONCOMITANT).

    Description of Event or Problem · 0

    SUBJECT ID: (B)(6), STUDY NO: (B)(4). CLINICAL ADVERSE EVENT RECEIVED FOR DISPLACED TYPE 2B SCAPULAR SPINE FRACTURE DEVICE (RELATEDNESS): PROBABLE PROCEDURE (RELATEDNESS): CAUSAL RELATIONSHIP DATE OF EVENT: 23 FEB 2023 DATE OF IMPLANT: NO INFORMATION PROVIDED DATE OF REVISION: (B)(6) 2025 DEVICE LOCATION: NO INFORMATION PROVIDED. TREATMENT/IMPACT: SURGICAL INTERVENTION FOR THE REGISTRY SHOULDER: YES, DATE OF SURGICAL INTERVENTION: 18 MAR 2026, OPEN REDUCTION INTERNAL FIXATION (ORIF): YES, COMPONENTS REMOVED (MARK NONE OR ALL THAT APPLY.) :(* PLEASE COMPLETE A PATIENT COMPLETION/DISCONTINUATION FORMNBSP; NONE: YES . DEPUY SYNTHES PRODUCTS USED: TYPE: SCREW CATALOG NUMBER: 130960315 LOT NUMBER: RL295828 DESCRIPTION: CENTRAL METAGLENE SCREW 6MM X 15MM. TYPE: SCREW CATALOG NUMBER: 130790024 LOT NUMBER: 5547930 DESCRIPTION: DELTA XTEND LOCKING SCREW 4.5 X 24. TYPE: SCREW CATALOG NUMBER: 130770018 LOT NUMBER: 5819790 DESCRIPTION: DELTA XTEND NON-LOCKING SCREW 4.5 X 18. TYPE: SCREW CATALOG NUMBER: 130790024 LOT NUMBER: 5552950 DESCRIPTION: DELTA XTEND LOCKING SCREW 4.5 X 24. TYPE: SCREW CATALOG NUMBER: 130770018 LOT NUMBER: 5829670 DESCRIPTION: DELTA XTEND NON-LOCKING SCREW 4.5 X 18. TYPE: COLLET CATALOG NUMBER: 130960111 LOT NUMBER: RL304653 DESCRIPTION: CENTRAL SCREW METAGLENE COLLET. TYPE: SHELL CATALOG NUMBER: 130738203 LOT NUMBER: 5568017 DESCRIPTION: DELTA XTEND HUMERAL CUP STD. 38 X+3. TYPE: EPIPHYSIS CATALOG NUMBER: 130720111 LOT NUMBER: 4093704 DESCRIPTION: XTEND MODULAR ECCENTRIC 145 EPI POROCOAT SIZE 1. TYPE: METAGLENE CATALOG NUMBER: 130970850 LOT NUMBER: 4117257 DESCRIPTION: AUGMENTED CENTRAL SCREW METAGLENE FULL WEDGE. TYPE: GLENOSPHERE CATALOG NUMBER: 130761138 LOT NUMBER: D22072589 DESCRIPTION: STANDARD GLENOSPHERE 38MM, +0 LATERALIZATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    42602 DXTEND SCREW NO LOCK D4.5X18MM DELTA XTEND IMPLANTS : SCREWS HSD DEPUY ORTHOPAEDICS INC US 5819790 10603295027782

    Patients

    Seq Age Sex Outcome Treatment
    1