BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ZIMMER TRABECULAR METAL REVERSE SHOULDER SYSTEM INSTRUMENTION PIN

    MDR report key: 6108850 · Received November 17, 2016

    Report

    Report Number
    6108850
    Event Type
    Malfunction
    Date Received
    November 17, 2016
    Date of Event
    October 25, 2016
    Report Date
    November 15, 2016
    Manufacturer
    ZIMMER TRABECULAR METAL TECHNOLOGY, INC.
    Product Code
    KWT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING TOEL SHOULDER, REVERSE, RIGHT END OF PIN BROKE. SURGEON LEFT IN PLACE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    761123 ZIMMER TRABECULAR METAL REVERSE SHOULDER SYSTEM INSTRUMENTION PIN PROSTHESIS, SHOULDER, NON-CONSTRAINED, METAL/POLYMER KWT ZIMMER TRABECULAR METAL TECHNOLOGY, INC. 2.5 MM 63339268

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR