BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VERSA-DIAL/COMP TI STD TAPER PR ADAPTOR

    MDR report key: 6828570 · Received August 29, 2017

    Report

    Report Number
    0001825034-2017-06876
    Event Type
    Injury
    Date Received
    August 29, 2017
    Report Date
    February 6, 2018
    Manufacturer
    BIOMET ORTHOPEDICS
    Product Code
    MBF
    PMA / PMN Number
    PK060716
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). CONCOMITANT MEDICAL PRODUCTS: COMP RVRS SHDR GLEN BSPLT +HA PART # 115330 LOT # 629650. COMP PRIMARY STEM 8 MM STD PART # 113648 LOT # 985870. COMP RVS HMRL TI TRAY 44 MM PART # 115340 LOT # 228430. COMP RVRS SHLDR GLNSP STD 36 MM PART # 115310 LOT # 239030. ARCOM XL 44-36 STD HMRL BRNG PART # XL-115363 LOT # 853780. MULTIPLE MDR REPORTS WERE FILED FOR THIS EVENT, PLEASE SEE ASSOCIATED REPORTS: 0001825034-2017-06871, 0001825034-2017-06872, 0001825034-2017-06873, 0001825034-2017-06874, 0001825034-2017-06875. IT IS UNKNOWN IF THE PRODUCT WILL BE RETURNED TO ZIMMER BIOMET FOR INVESTIGATION. THE INVESTIGATION IS IN PROCESS. ONCE THE INVESTIGATION HAS BEEN COMPLETED, A FOLLOW-UP MDR WILL BE SUBMITTED.

    Additional Manufacturer Narrative · 1

    (B)(4). THIS FOLLOW-UP REPORT IS BEING SUBMITTED TO RELAY CORRECTED INFORMATION.

    Description of Event or Problem · 1

    IT IS REPORTED THAT THE PATIENT RECEIVED A COMPREHENSIVE REVERSE SHOULDER 5 1/2 YEARS AGO. IT HAS BEEN FURTHER REPORTED THAT THE PATIENT IS BEING CONSIDERED FOR A REVISION DUE TO UNKNOWN REASONS.  ATTEMPTS HAVE BEEN TO FIND MORE INFORMATION MADE BUT NO MORE INFORMATION IS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    607603 VERSA-DIAL/COMP TI STD TAPER PR ADAPTOR PROSTHESIS, SHOULDER MBF BIOMET ORTHOPEDICS N/A 362020

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Other