MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2015-08-26 for UNKNOWN ZIMMER B/F HUMERAL STEM manufactured by Zimmer Inc.
[24163113]
(b)(4). Other devices used: catalog #unk, unknown zimmer b/f humeral head, lot #unk; catalog #unk, unknown zimmer b/f glenoid, lot #unk. This report will be amended when our investigation is complete.
Patient Sequence No: 1, Text Type: N, H10
[24163114]
It is reported the patient fell on their operative arm while trying to take the bumper off of his car.
Patient Sequence No: 1, Text Type: D, B5
[28850767]
The provided operative notes are vague, as such; no definitive statements can be made regarding the surgical technique. No devices or photos were received; therefore, the condition of the components is unknown. The part and lot numbers of the product are unknown; therefore, the device history records could not be reviewed. These products were used for treatment. The complaint history for these products could not be reviewed due to the lack of lot numbers. It could not be confirmed if the devices are an approved and compatible combination. The investigation could not verify or identify any evidence of product contribution to the reported problem. Based on the available information, the need for corrective action is not indicated. A definitive root cause cannot be determined with the information provided.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1822565-2015-01596 |
| MDR Report Key | 5033051 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2015-08-26 |
| Date of Report | 2015-07-29 |
| Date of Event | 2003-10-01 |
| Date Mfgr Received | 2015-10-19 |
| Date Added to Maude | 2015-08-26 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | KEVIN ESCAPULE |
| Manufacturer Street | P.O. BOX 708 |
| Manufacturer City | WARSAW IN 465810708 |
| Manufacturer Country | US |
| Manufacturer Postal | 465810708 |
| Manufacturer Phone | 8006136131 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | UNKNOWN ZIMMER B/F HUMERAL STEM |
| Generic Name | SHOULDER PROSTHESIS |
| Product Code | KWR |
| Date Received | 2015-08-26 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ZIMMER INC |
| Manufacturer Address | P.O. BOX 708 WARSAW IN 465810708 US 465810708 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2015-08-26 |