MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2020-02-05 for ANATOMICAL SHOULDER REVERSE, SCREW SYSTEM, 4.5-42 N/A 01.04223.042 manufactured by Zimmer Gmbh.
[177846556]
Medical product: cement; catalog# : 85225; lot# : 402282, musculoskeletal transplant fnd; catalog# : 81207; lot# : n/s, base plate 25 mm post length +2 mm lateral offset uncemented; catalog# : 00434902502; lot# : 63685438, glenosphere 36 mm diameter; catalog# : 00434903611; lot# : 63736824, comp rvs tray co 44mm; catalog# : 115370; lot# : 795950, arcom xl 44-36 std +3 hmrl brg; catalog# : xl-115364; lot# : 927530. The manufacturer received x-rays, or other source documents for review. The manufacturer did not receive the device for investigation. Where lot numbers were received for the devices, the device history records were reviewed and found to be conforming. A cause for this specific event cannot be ascertained from the information provided. As soon as supplemental information becomes available an updated report will be submitted. Zimmer biomet? S reference number of this file is (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[177846557]
Patient was implanted on the left side and revision surgery has been planned for radiolucency.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0009613350-2020-00047 |
| MDR Report Key | 9671006 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2020-02-05 |
| Date of Report | 2020-02-05 |
| Date of Event | 2019-08-22 |
| Date Mfgr Received | 2020-01-14 |
| Device Manufacturer Date | 2017-07-20 |
| Date Added to Maude | 2020-02-05 |
| 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. CHRISTINA ARNT |
| Manufacturer Street | 56 E. BELL DR. |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal | 46582 |
| Manufacturer Phone | 5745273773 |
| Manufacturer G1 | ZIMMER GMBH |
| Manufacturer Street | SULZER ALLEE 8 SULZER INDUSTRIE PARK |
| Manufacturer City | WINTERTHUR 8404 |
| Manufacturer Country | SZ |
| Manufacturer Postal Code | 8404 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | N/A |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ANATOMICAL SHOULDER REVERSE, SCREW SYSTEM, 4.5-42 |
| Generic Name | INVERSE/REVERSE SCREW, 4.5 ? 42MM |
| Product Code | KWT |
| Date Received | 2020-02-05 |
| Model Number | N/A |
| Catalog Number | 01.04223.042 |
| Lot Number | 2908167 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ZIMMER GMBH |
| Manufacturer Address | SULZER ALLEE 8 SULZER INDUSTRIE PARK WINTERTHUR 8404 SZ 8404 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2020-02-05 |