MAUDE Adverse Event Report: DEPUY ORTHOPAEDICS INC US XTNDGLENO D38MM +0MM SHRTPST; DELTA XTEND LATERALIZED GLENOSPHERE

Model Number	1307-61-138
Medical Device Problem Codes	Difficult to Insert (1316); Device Damaged Prior to Use (2284)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/09/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Event or Problem Description
Surgeon had trouble getting glenosphere implant (1307-61-138) to engage in metaglene.He tried to get the implant seated and thread down the screw but it wouldn't engage.Eventually he pulled out the implant and found the threads had been damaged.He ended up implanting the original glenosphere version (1307-60-138) and suggested that the longer threads on that version may have helped it to engage.This was very similar to what happened in the last reverse shoulder case he did.He suggested also that the shoulder was very small and difficult to expose.See (b)(4).
Additional Manufacturer Narrative
Product complaint # (b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by depuy synthes joint reconstruction, or its employees that the report constitutes an admission that the product, depuy synthes joint reconstruction, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
Additional Manufacturer Narrative
Product complaint # (b)(4).Investigation summary = > examination of the returned device found could confirm the reported allegation.Depuy synthes considers the investigation closed at this time.Should additional information be received, the information will be reviewed and the investigation may be re-opened as necessary.Device history lot = > has reviewed the device history record (dhr) review was conducted by the manufacturing site for the finished device 130761138, lot number d21052475, it was manufactured on 23-may-2021.(b)(4) parts were manufactured per specification and all raw materials met specification, and no non-conformances were identified.

• Brand Name: XTNDGLENO D38MM +0MM SHRTPST
• Common Device Name: DELTA XTEND LATERALIZED GLENOSPHERE
• Manufacturer (Section D): DEPUY ORTHOPAEDICS INC US; 700 orthopaedic drive; warsaw IN 46581 0988
• Manufacturer (Section G): JJM (SUZHOU) LTD. 3006356043; no.299 changyang st; suzhou industrial park; suzhou jiangsu 21512 -6; CH 21512-6
• Manufacturer Contact: kara ditty-bovard ; 700 orthopaedic dr.; warsaw, IN 46581-0988 ; 6107428552
• MDR Report Key: 12863379
• Report Number: 1818910-2021-26260
• Device Sequence Number: 4364021
• Product Code: PHX
• UDI-Device Identifier: 10603295502555
• UDI-Public: 10603295502555
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K192855
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 11/09/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: 1307-61-138
• Device Catalogue Number: 130761138
• Device Lot Number: D21052475
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/07/2021
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/09/2021
• Supplement Date Received by Manufacturer: 12/07/2021; 02/01/2022
• Initial Report FDA Received Date: 11/23/2021
• Supplement Report FDA Received Date: 12/29/2021; 02/01/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 05/27/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Female