MAUDE Adverse Event Report: ZIMMER BIOMET, INC. CR VIVACIT-E 40MM BRNG +3; EXTREMITIES IMPLANTS

Model Number	N/A
Medical Device Problem Code	Difficult to Insert (1316)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/15/2022
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that during a surgery before implantation it was found that the humeral bearing poly was shifting roughly 1-3 mm in either direction.The bearing was then disassociate from the humeral tray with the surgeon's hands, and the humeral bearing broke off.The surgeon then proceeded to try another poly.It did the exact same thing, except the tabs did not break on the second poly.We then tried a third 40 +3 poly which did the exact some thing as the previous two, except the doctor left the bearing in the patient and finished the case.Attempts have been made and there is no further information at this time.
Additional Manufacturer Narrative
(b)(4).Concomitant medical products - medical product: catalog #: 110031428, cr vivacit-e 40 mm brng +3, lot # 65164152, catalog #: 110031428, cr vivacit-e 40 mm brng +3, lot # 65163939, and catalog #: unknown, unknown tray, lot # unknown.The customer has not indicated whether the product will be returned to zimmer biomet for investigation or not.Once this information is obtained a follow-up mdr will be submitted.Multiple mdr reports were filed for this event, please see associated reports: 0001822565-2022-02574, 0001822565-2022-02575, 0001822565-2022-02577 remains implanted.
Event or Problem Description
No further event information available at the time of this report.
Additional Manufacturer Narrative
(b)(4).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.
Additional Manufacturer Narrative
(b)(4).Reported event was unable to be confirmed due to limited information received from the customer.Device history record was reviewed and no discrepancies relevant to the reported event were found.A definitive root cause could not be determined.This event was further investigated through the capa process.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 or Problem Description
No further event information available at the time of this report.
Event or Problem Description
After further review, it was determined that this product should be not reportable.
Additional Manufacturer Narrative
(b)(4).After further review, it was determined that this product is a comprehensive mini.The comprehensive mini product line is not same or similar to the comprehensive reverse product line.Further, this product's malfunction did not cause a serious injury and has not in the past.Therefore, this should be not reportable.

• Brand Name: CR VIVACIT-E 40MM BRNG +3
• Common Device Name: EXTREMITIES IMPLANTS
• 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: 15373290
• Report Number: 0001822565-2022-02576
• Device Sequence Number: 11168529
• Product Code: KWS
• UDI-Device Identifier: 00887868231599
• UDI-Public: (01)00887868231599(17)260415(10)64980845
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: K181611
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Company Representative,Distributor
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 05/01/2024

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 Expiration Date: 04/15/2026
• Device Model Number: N/A
• Device Catalogue Number: 110031428
• Device Lot Number: 64980845
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/17/2022
• Supplement Date Received by Manufacturer: 09/28/2022; 11/10/2022; 04/30/2024
• Initial Report FDA Received Date: 09/07/2022
• Supplement Report FDA Received Date: 10/26/2022; 11/23/2022; 05/01/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 05/04/2021
• 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: Initial
• If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement: N/A
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SEE H10.
• Patient Sex: Male