MAUDE Adverse Event Report: ZIMMER BIOMET, INC. BASE PLATE 25 MM POST LENGTH +2 MM LATERAL OFFSET UNCEMENTED; PROSTHESIS, SHOULDER

Model Number N/A

Device Problem Insufficient Information (3190)

Patient Problem Pneumothorax (2012)

Event Date 02/16/2016

Event Type  Injury  

Manufacturer Narrative

(b)(4).Customer has indicated that the product will not be returned to zimmer biomet for investigation, as the device remains implanted.The investigation is in process.Once the investigation has been completed, a follow-up mdr will be submitted.Concomitant medical products: 00434901013, humeral stem, lot 63012698, 00434903600, poly liner, lot 63028247, 00434903611, glenosphere, lot 63076788.Report source: (b)(6).Multiple mdr reports were filed for this event, please see associated reports: 0001822565 - 2019 - 01060, 0001822565 - 2019 - 01061, 0001822565 - 2019 - 01062.

Event Description

It was reported that during the patient's primary surgery, a scalene block was administered, and the patient subsequently developed pneumothorax.The use of a chest tube was required to intervene, and the patient spent approximately 8 more days in the hospital due to the pneumothorax.Attempts have been made and no further information has been provided.

Manufacturer Narrative

Reported event was confirmed via medical records.Review of the device history record(s) identified no related deviations or anomalies during manufacturing.A definitive root cause cannot be determined.If any further information is found which would change or alter any conclusions or information, a supplemental will be filed accordingly.Zimmer biomet will continue to monitor for trends.

Event Description

No further event information available at the time of this report.

• Brand Name: BASE PLATE 25 MM POST LENGTH +2 MM LATERAL OFFSET UNCEMENTED
• Type of Device: PROSTHESIS, SHOULDER
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 56 e. bell drive; warsaw IN 46582
• MDR Report Key: 8421717
• MDR Text Key: 138826305
• Report Number: 0001822565-2019-01063
• Device Sequence Number: 1
• Product Code: KWT
• Combination Product (y/n): N
• PMA/PMN Number: K130661
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor,foreign,health pr
• Type of Report: Initial,Followup
• Report Date: 06/06/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/14/2019
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 10/31/2023
• Device Model Number: N/A
• Device Catalogue Number: 00434902502
• Device Lot Number: 62514115
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 05/30/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization; Required Intervention
• Patient Weight: 70