BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZIMMER TM REVERSE GLENOSPHERE

    MDR report key: 3102125 · Received April 26, 2013

    Report

    Report Number
    1822565-2013-00714
    Event Type
    Injury
    Date Received
    April 26, 2013
    Date of Event
    September 12, 2011
    Report Date
    March 27, 2013
    Manufacturer
    ZIMMER, INC.
    Product Code
    HSD
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    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 GLENOID BONE LOSS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    181500 ZIMMER TM REVERSE GLENOSPHERE HSD ZIMMER, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention LOT# UNK| ZIMMER TM REVERSE BASE PLATE: CAT#00434903811,