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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ARTHREX, INC. GLENOID, PE WITH PEG, MEDIUM; PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED
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ARTHREX, INC. GLENOID, PE WITH PEG, MEDIUM; PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED Back to Search Results
Model Number GLENOID, PE WITH PEG, MEDIUM
Health Effect - Clinical Code Insufficient Information (4580)
Date of Event 12/11/2020
Type of Reportable Event Serious Injury
Additional Manufacturer Narrative
The contribution of the device to the reported event could not be determined as the device was not returned for evaluation.The root cause of the event could not be determined from the information available and without device evaluation.
 
Event or Problem Description
It was reported that the patient underwent surgery approximately 6 years ago.The x-ray showed the pe glenoid dislocated inferiorly.The revision surgery was performed with a device from another manufacturer.Update 23-dec-2020: the revision surgery of the eclipse took place on (b)(6) 2020.
 
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Brand Name
GLENOID, PE WITH PEG, MEDIUM
Common Device Name
PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED
Manufacturer (Section D)
ARTHREX, INC.
1370 creekside boulevard
naples FL 34108 1945
MDR Report Key11117130
Report Number1220246-2021-02443
Device Sequence Number17124325
Product Code KWS
UDI-Device Identifier00888867057326
UDI-Public00888867057326
Combination Product (Y/N)N
Initial Reporter CountrySZ
PMA/510(K) Number
K083435
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source foreign,health professional,u
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 01/05/2021
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
Operator of Device Health Professional
Device Model NumberGLENOID, PE WITH PEG, MEDIUM
Device Catalogue NumberAR-9105-02
Was Device Available for Evaluation? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 12/12/2020
Initial Report FDA Received Date01/05/2021
Patient Sequence Number1
Outcome Attributed to Adverse Event Other;
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