MAUDE Adverse Event Report: ENCORE MEDICAL L.P. ALTIVATE SHOULDER; ALTIVATE ANATOMIC, NEUTRAL HUMERAL HEAD, 50X18

Model Number 520-50-218

Device Problem Device Dislodged or Dislocated (2923)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 05/02/2019

Event Type  Injury  

Manufacturer Narrative

The reason for this revision surgery was due to dislocation.The previous surgery and the revision detailed in this investigation occurred over 3 months apart.There is no information in this complaint about any patient injuries, activities, or accidents that may have contributed to the need for this revision surgery.There are no reported pre-existing patient health conditions.The healthcare professional indicated there was no delay in surgery and another suitable device was available for use.The revision surgery was completed as intended.The device was disposed of at the hospital and not made available to djo surgical for examination.A review of the implant device history records (dhr) shows that the reported component used in the previous surgery met design and manufacturing requirements.There were no non-conforming material reports (ncmrs) associated with the product that may have contributed to the event.The device was within its expiration date at the time of use during the previous surgery.Customer complaint history of the reported device showed no present trends or on-going issues that are in need of review.The root cause of this complaint was a revision surgery due to dislocation.There were no findings during this investigation that indicate that the reported device was the source or had a direct connection with the patient's event.There are multiple factors that may contribute to the event that are outside the control of djo surgical are patient age, patient activities, inadequate soft tissue, excessive range-of-motion, excessive load or trauma.Inventory containment is not required as there are no indications of a product or process issue affecting implant safety or effectiveness.

Event Description

Revision surgery - due to dislocation per sizing.The surgeon revised to a total.

• Brand Name: ALTIVATE SHOULDER
• Type of Device: ALTIVATE ANATOMIC, NEUTRAL HUMERAL HEAD, 50X18
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd; austin TX 78758 5445
• Manufacturer (Section G): ENCORE MEDICAL L.P.; 9800 metric blvd; austin TX 78758 5445
• Manufacturer Contact: teffany hutto ; 9800 metric blvd; austin, TX 78758-5445
• MDR Report Key: 8660146
• MDR Text Key: 146719024
• Report Number: 1644408-2019-00499
• Device Sequence Number: 1
• Product Code: PAO
• UDI-Device Identifier: 00190446176138
• UDI-Public: (01)00190446176138
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K162024
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date: 05/31/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/31/2019
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 520-50-218
• Device Catalogue Number: 520-50-218
• Device Lot Number: 949U1050
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 05/02/2019
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 11/29/2018
• 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: 520-07-000, LOT 888U1239
• Patient Outcome(s): Required Intervention
• Patient Age: 48 YR