MAUDE Adverse Event Report: ZIMMER BIOMET, INC. TM RVS BASE PLT 25MM POST +2; PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED/EXTREMITIES

Catalog Number 00834902502

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Pain (1994); Numbness (2415)

Event Date 03/29/2013

Event Type  Injury  

Event Description

It was reported that a patient underwent a right reverse shoulder arthroplasty.Subsequently, approximately a month and a half after the surgery the patient reported an increase of pain down their arm.The patient was diagnosed with nerve pain with numbness and prescribed a medication (lyrica 75mg).The patient is satisfied and all implant remain implanted.

Manufacturer Narrative

(b)(4).Multiple mdr reports were filed for this event, please see associated reports: 0001822565-2022-02636, 0001822565-2022-02637, 0001822565-2022-02638, 0001822565-2022-02677, 0001822565-2022-02678.Concomitant medical products: item#: 00434901213, 12mm a 130mm length humeral stem; lot#: 62248463, item#: 00434903603, 36mm a +3mm offset poly liner; lot#: 62114032, item#: 00434903611, 36mm a glenosphere; lot#: 62234748, item#: unknown, unknown screw length 36; lot#: unknown, item#: unknown, unknown screw length 42; lot#: unknown, item#: unknown, unknown glenoid bone void filler- autograft (glenoid); lot#: unknown, item#: unknown, unknown simplex cement; lot#: unknown.Customer has indicated that the product will not be returned to zimmer biomet for investigation, as the product remains implanted.The investigation is in process.Once the investigation has been completed, a follow-up mdr will be submitted.

Manufacturer Narrative

(b)(4).This follow-up report is being submitted to relay additional information.Multiple mdr reports were filed for this event, please see associated reports: 0001822565-2022-02636-1, 0001822565-2022-02637-1, 0001822565-2022-02638-1, 0001822565-2022-02676-1, 0001822565-2022-02678-1.No product was returned, or pictures provided; visual and dimensional evaluations could not be performed.Review of the device history record(s) identified no deviations or anomalies during manufacturing related to the reported event.Medical records were provided and reviewed by a health care professional and a timeline was created.Review of the available records identified the following: (b)(6) 2013; visit , improving; satisfied, anteroposterior & axillary images taken: no significant findings ae increase in pain due to suspected nerve pain; prescribed lyrica 75 mg.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: TM RVS BASE PLT 25MM POST +2
• Type of Device: PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED/EXTREMITIES
• Manufacturer (Section D): ZIMMER BIOMET, INC.; 1800 w. center st.; warsaw IN 46580
• Manufacturer (Section G): ZIMMER BIOMET, INC.; 1800 w. center st.; warsaw IN 46580
• Manufacturer Contact: jennifer rapsavage ; 56 e. bell dr.; warsaw, IN 46582 ; 5745260384
• MDR Report Key: 15418942
• MDR Text Key: 299868760
• Report Number: 0001822565-2022-02676
• Device Sequence Number: 1
• Product Code: KWT
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K121543
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Study,Health Professional,Company Representative
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date: 11/18/2022

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: Health Professional
• Device Expiration Date: 01/31/2023
• Device Catalogue Number: 00834902502
• Device Lot Number: 62274777
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Initial Date Manufacturer Received: 08/18/2022
• Initial Date FDA Received: 09/14/2022
• Supplement Dates Manufacturer Received: 11/11/2022
• Supplement Dates FDA Received: 11/18/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 01/25/2013
• 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: SEE H10 NARRATIVE
• Patient Outcome(s): Required Intervention
• Patient Age: 66 YR
• Patient Sex: Male
• Patient Weight: 78 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: White