MAUDE Adverse Event Report: TORNIER INC UNKNOWN TORNIER HRS PROXIMAL BODY; PROSTHESIS, SHOULDER, HEMI-, HUMERAL, METALLIC UNCEMENTED

Catalog Number UNK_WTB

Device Problem Osseointegration Problem (3003)

Patient Problems Osteolysis (2377); Inadequate Osseointegration (2646)

Event Date 07/24/2023

Event Type  Injury  

Event Description

The tornier shoulder outcomes study's patient experienced a revision surgery due to issues with loosening/lysis.During the procedure, a glenoid sphere was removed and replaced with a reversed-lateralized glenosphere that was 3mm larger (39mm).An additional update revealed that the tornier hrs ars741701 was also removed during the surgery.

Manufacturer Narrative

Device will not be returned.If additional information becomes available, it will be provided on a supplemental report.H3 other text : device disposition is unknown.

Event Description

The tornier shoulder outcomes study's patient experienced a revision surgery due to issues with loosening/lysis.During the procedure, a glenoid sphere was removed and replaced with a reversed-lateralized glenosphere that was 3mm larger (39mm).An additional update revealed that the tornier hrs ars741701 was also removed during the surgery.

Manufacturer Narrative

The reported event was not confirmed, since the device was not returned for evaluation and no other evidences were provided.The device inspection was not possible as the product was not returned for investigation.The device history record could not be reviewed because the affected device was not returned, and the lot number was not communicated.A review of the labeling did not indicate any abnormalities.More detailed information about the complaint event as well as the affected device must be available in order to determine the root cause of the complaint event.If device is returned or any further information is provided, the investigation report will be reassessed.

• Brand Name: UNKNOWN TORNIER HRS PROXIMAL BODY
• Type of Device: PROSTHESIS, SHOULDER, HEMI-, HUMERAL, METALLIC UNCEMENTED
• Manufacturer (Section D): TORNIER INC; 10801 nesbitt avenue s; bloomington MN 55437
• Manufacturer (Section G): TORNIER INC; 10801 nesbitt avenue s; bloomington MN 55437
• Manufacturer Contact: anna jusinski ; 325 corporate drive; mahwah, NJ 07430 ; 2018315000
• MDR Report Key: 17602972
• MDR Text Key: 321733502
• Report Number: 0001649390-2023-00206
• Device Sequence Number: 1
• Product Code: HSD
• UDI-Device Identifier: 00846832092703
• UDI-Public: 00846832092703
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K181420
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Health Professional
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date: 10/19/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Lay User/Patient
• Device Catalogue Number: UNK_WTB
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 07/28/2023
• Initial Date FDA Received: 08/23/2023
• Supplement Dates Manufacturer Received: 09/21/2023
• Supplement Dates FDA Received: 10/19/2023
• 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
• Patient Outcome(s): Required Intervention
• Patient Age: 60 YR
• Patient Sex: Female
• Patient Weight: 99 KG