Brand Name | GLBL UNITE ANT BODY 135 SZ 14 |
Type of Device | GLOBAL UNITE IMPLANTS : SHOULDER HUMERAL STEM ACCESSORY |
Manufacturer (Section D) |
DEPUY IRELAND - 9616671 |
loughbeg ringaskiddy co. |
cork |
EI |
|
Manufacturer (Section G) |
DEPUY IRELAND 9616671 |
loughbeg, ringaskiddy co. |
|
cork |
EI
|
|
Manufacturer Contact |
kara
ditty-bovard
|
700 orthopaedic dr. |
warsaw, IN 46581-0988
|
6107428552
|
|
MDR Report Key | 13667197 |
MDR Text Key | 286575654 |
Report Number | 1818910-2022-04107 |
Device Sequence Number | 1 |
Product Code |
HSD
|
UDI-Device Identifier | 10603295004639 |
UDI-Public | 10603295004639 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K170748 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,Company Representative |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial,Followup |
Report Date |
03/04/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/04/2022 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | 1100-50-000 |
Device Catalogue Number | 110050000 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 03/01/2022 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Treatment | CROSSLINK ANCHOR PG GLENOID 52; GLBL UNITE ANT BODY 135 SZ 14; GLOBAL UNITE HEAD 48X18 ECC; UNK SHOULDER STEM |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 66 YR |
Patient Sex | Male |