MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2018-06-20 for UNKNOWN SHOULDER HUMERAL CUP UNK SHOULDER HUMERAL CUP manufactured by Depuy Orthopaedics Inc Us 1818910.
[111690486]
If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10
[111690487]
Der states that the patient was using a roof rake to remove snow from his roof after a recent snowstorm. He was pulling back on the rake and felt a pop in his shoulder. X-ray showed his glenosphere and metaglene looked displaced. In surgery, the metaglene, glenosphere and screws came out in one piece. A cta head was replaced due to the damage done to his glenoid. It was also reported in the der that there was poly wear around the liner's periphery and loosening of the metaglene, glenosphere and screws at bone to implant interface. Doi: (b)(6) 2015; dor: (b)(6) 2018; right shoulder.
Patient Sequence No: 1, Text Type: D, B5
[128665881]
Product complaint # (b)(4). Investigation summary: no device associated with this report was received for examination. Depuy synthes considers the investigation closed. Should additional information be received, the information will be reviewed and the investigation may be re-opened as necessary. If information is obtained that was not available for the initial medwatch , a follow-up medwatch, a follow-up medwatch will be filed as appropriate.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1818910-2018-62667 |
| MDR Report Key | 7619832 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2018-06-20 |
| Date of Report | 2018-04-03 |
| Date of Event | 2018-04-03 |
| Date Mfgr Received | 2018-11-26 |
| Date Added to Maude | 2018-06-20 |
| 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 | MS. KARA DITTY-BOVARD |
| Manufacturer Street | 1210 WARD AVENUE |
| Manufacturer City | WEST CHESTER IN 193800988 |
| Manufacturer Country | US |
| Manufacturer Postal | 193800988 |
| Manufacturer Phone | 6103142063 |
| Manufacturer G1 | DEPUY ORTHOPAEDICS INC US 1818910 |
| Manufacturer Street | 700 ORTHOPAEDIC DRIVE |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 46582 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | UNKNOWN SHOULDER HUMERAL CUP |
| Generic Name | UNKNOWN SHOULDER IMPLANT |
| Product Code | MJT |
| Date Received | 2018-06-20 |
| Catalog Number | UNK SHOULDER HUMERAL CUP |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DEPUY ORTHOPAEDICS INC US 1818910 |
| Manufacturer Address | 700 ORTHOPAEDIC DRIVE WARSAW IN 465820988 US 465820988 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2018-06-20 |