MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,health profession report with the FDA on 2015-09-10 for UNKNOWN ZIMMER SHOULDER LINER manufactured by Zimmer Inc.
[25411712]
Information was received from a distributor who is not required to complete form 3500a. (b)(4). This report will be amended when our investigation is complete.
Patient Sequence No: 1, Text Type: N, H10
[25411713]
It is reported the patient was revised due to a loose bearing.
Patient Sequence No: 1, Text Type: D, B5
[32228568]
Operative notes were requested however none provided. Relevant medical history and adherence to rehabilitation protocol are unknown. No devices or photos were received; therefore the condition of the component is unknown. The part and lot numbers of the product are unknown; therefore the device history records could not be reviewed. The product was used for treatment. The complaint history for this product could not be reviewed due to the lack of lot numbers. It could not be confirmed if the devices used are an approved and compatible combination. A definitive root cause cannot be determined with the information provided. 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. Should additional substantive information be received, the complaint will be reopened. Zimmer, inc. Considers the investigation closed.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1822565-2015-01767 |
| MDR Report Key | 5068057 |
| Report Source | DISTRIBUTOR,HEALTH PROFESSION |
| Date Received | 2015-09-10 |
| Date of Report | 2015-08-18 |
| Date of Event | 2015-08-18 |
| Date Mfgr Received | 2015-11-03 |
| Date Added to Maude | 2015-09-10 |
| 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 |
| Reporter Occupation | MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE |
| 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 SHOULDER LINER |
| Generic Name | SHOULDER PROSTHESIS |
| Product Code | KWR |
| Date Received | 2015-09-10 |
| 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. Required No Informationntervention | 2015-09-10 |