BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ZIMMER TM REVERSE SHOULDER GLENOSPHERE

    MDR report key: 3946358 · Received July 10, 2014

    Report

    Report Number
    1822565-2014-00839
    Event Type
    Injury
    Date Received
    July 10, 2014
    Date of Event
    October 5, 2012
    Report Date
    June 10, 2014
    Manufacturer
    ZIMMER, INC.
    Product Code
    HSD
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    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 PATIENT WAS REVISED DUE TO DISLOCATION OF THE GLENOSPHERE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    404467 ZIMMER TM REVERSE SHOULDER GLENOSPHERE HSD ZIMMER, INC. 62032987

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention ZIMMER TM REVERS SHOULDER BASE PLATE| CAT #00434903811, LOT #62019402