FDA Adverse Event
Injury
Summary report: N
ZIMMER TM REVERSE SHOULDER BASE PLATE
MDR report key: 3971265
·
Received June 30, 2014
Report
- Report Number
- 1822565-2014-00793
- Event Type
- Injury
- Date Received
- June 30, 2014
- Report Date
- June 6, 2014
- Manufacturer
- ZIMMER, INC.
- Product Code
- HSD
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Occupation
- OTHER
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 IS EXPERIENCING PAIN A "CATCHING" FEELING WHEN HE RAISES HIS ARM. THE PT HAS BEEN DIAGNOSED WITH A MILDLY DISPLACED FRACTURE OF THE RIGHT SCAPULAR SPINE/ACROMION PROCESS.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 378784 | ZIMMER TM REVERSE SHOULDER BASE PLATE | SHOULDER PROSTHESIS | HSD | ZIMMER, INC. | 62439401 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |