MAUDE Adverse Event Report: TORNIER INC UNKNOWN PERFORM REVERSE SCREWDRIVER; SHOULDER PROSTHESIS, REVERSE CONFIGURATION

Catalog Number UNK_WTB

Device Problems Break (1069); Fracture (1260)

Patient Problems Bacterial Infection (1735); Foreign Body In Patient (2687); Implant Pain (4561)

Event Date 10/10/2022

Event Type  Injury  

Event Description

It was reported that a patient was experiencing pain.The patient planned on performing a biopsy to confirm the presence of an infection.Aspiration confirmed the presence of c.Acnes bacteria as the cause of infection.There was a revision surgery performed.All humeral components were taken out, screw driver broke off in the patient, and baseplate couldn't be removed.The broken fragment of the screwdriver was left in the patient.This was during a staged procedure.Procedure had to be adapted to account for the fact that all the implants could not be explanted from the patient.Antibiotic spacer was put in.Patient had a previous cuff repair on their shoulder.Date unknown.

Manufacturer Narrative

Based on the available information the device will not be returned therefore an evaluation of the device cannot be performed.A review of the device history is not possible because the lot number was not communicated.Should additional information become available, it will be provided on a supplemental report.Device disposition is unknown.

• Brand Name: UNKNOWN PERFORM REVERSE SCREWDRIVER
• Type of Device: SHOULDER PROSTHESIS, REVERSE CONFIGURATION
• 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: 15744820
• MDR Text Key: 303171582
• Report Number: 0001649390-2022-00095
• Device Sequence Number: 1
• Product Code: PHX
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 11/07/2022

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?: Yes
• Device Operator: Lay User/Patient
• Device Catalogue Number: UNK_WTB
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 10/10/2022
• Initial Date FDA Received: 11/07/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 58 YR