MAUDE Adverse Event Report: STRYKER GMBH 4.5MM PERIPHERAL SCREW - 40MM; PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED

Model Number	5572-4540
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Metal Related Pathology (4530)
Date of Event	10/06/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Analysis results are not available at the time of this report.A follow-up report will be sent when the analysis is complete.
Event or Problem Description
It was reported that a patient underwent had their shoulder stem removed 6 weeks post opp due to metallosis.
Additional Manufacturer Narrative
The reported event could not be confirmed.The device inspection revealed the following: the lot # of the returned 4.5mm peripheral screw - 40mm could not be identified.The screw is relatively new, no major wear mark was visible.It was not possible to determine if metallic particles were created.It was not possible to confirm the reported metallosis, as not enough information was provided in this case.Furthermore, as indicated by medical experts, "metallosis is about the type-iv immune response to the accumulation of metal particles within tissues.There are cases of early arthroplasty failure due to metallosis, yet these patients usually do well initially and start to get pain and joint stiffness after months, leading to revision within 2 years.".However, the reported metallosis was observed after 6 weeks of implantation, a post-surgical lapse of time much shorter than what is usually observed for such response.This gives further indication of the lack of evidence pointing towards metallosis and the impossibility to confirm the reported event.Based on the investigation, no problem could be detected on the screw and the link with a possible metallosis could not be established.A review of the device history for the reported lot did not indicate any abnormalities.No corrective actions are required at this time.A review of the labeling did not indicate any abnormalities.No indications of material, manufacturing or design related problems were found during the investigation.If more information is provided, the case will be reassessed.
Event or Problem Description
It was reported that a patient underwent had their shoulder stem removed 6 weeks post opp due to metallosis.

• Brand Name: 4.5MM PERIPHERAL SCREW - 40MM
• Common Device Name: PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED
• Manufacturer (Section D): STRYKER GMBH; bohnackerweg 1; postfach; selzach 2545 ; SZ 2545
• Manufacturer (Section G): STRYKER GMBH; bohnackerweg 1; postfach; selzach 2545 ; SZ 2545
• Manufacturer Contact: anna jusinski ; 325 corporate drive; mahwah, NJ 07430 ; 2018315000
• MDR Report Key: 15883197
• Report Number: 0008031020-2022-00658
• Device Sequence Number: 11854688
• Product Code: KWS
• UDI-Device Identifier: 07613327098778
• UDI-Public: 07613327098778
• Combination Product (Y/N): N
• Initial Reporter State: WA
• Initial Reporter Country: US
• PMA/510(K) Number: K130895
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Explanted Year: 2022
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 01/19/2023
• 2 Devices were Involved in the Event: 1 2

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Lay User/Patient
• Device Model Number: 5572-4540
• Device Catalogue Number: 5572-4540
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/26/2022
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 11/03/2022
• Supplement Date Received by Manufacturer: 12/23/2022
• Initial Report FDA Received Date: 11/29/2022
• Supplement Report FDA Received Date: 01/19/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown