BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TM REVERSE SHOULDER BASEPLATE

    MDR report key: 2843468 · Received November 15, 2012

    Report

    Report Number
    1822565-2012-02342
    Event Type
    Injury
    Date Received
    November 15, 2012
    Date of Event
    September 10, 2012
    Report Date
    October 17, 2012
    Manufacturer
    ZIMMER, INC.
    Product Code
    HSD
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS REPORT WILL BE AMENDED WHEN OUR INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE PT WAS REVISED DUE TO PAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TM REVERSE SHOULDER BASEPLATE HSD ZIMMER, INC. 61552639

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Required Intervention TM REVERSE GLENOSPHERE: CATALOG #00434903611,| LOT #61540256