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 2016-03-11 for UNKNOWN BIGLIANI/FLATOW HUMERAL COMPONENT manufactured by Zimmer Inc.
[40150574]
Information was received via published literature. Please reference literature at the following location: http://www. Jshoulderelbow. Org/article/s1058-2746(12)00182-6/pdf (b)(4). This report will be amended when our investigation is complete.
Patient Sequence No: 1, Text Type: N, H10
[40150575]
It is reported that posterior subluxation was noted radiographically for one patient.
Patient Sequence No: 1, Text Type: D, B5
[49964836]
No devices or photos were received; therefore the condition of the components is unknown. Device history records cannot be reviewed since the part and lot numbers are unknown. These devices are used for treatment. Surgical notes were not provided; it is unknown whether the components were implanted with the correct fit and orientation as per the surgical technique. Product history search cannot be completed and compatibly cannot be verified since the part and lot numbers are unknown. Patient? S adherence to rehabilitation protocol is unknown. A definite root cause cannot be determined with the information provided.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1822565-2016-00618 |
| MDR Report Key | 5495024 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2016-03-11 |
| Date of Report | 2016-02-15 |
| Date Mfgr Received | 2016-07-07 |
| Date Added to Maude | 2016-03-11 |
| 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 |
| Removal Correction Number | N/A |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | UNKNOWN BIGLIANI/FLATOW HUMERAL COMPONENT |
| Generic Name | SHOULDER PROSTHESIS |
| Product Code | KWR |
| Date Received | 2016-03-11 |
| 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 | 2016-03-11 |