MAUDE Adverse Event Report: EXACTECH, INC. EQ REV GLENOID PLATE; PROSTHESIS, SHOULDER, NON-CONSTRAINED, METAL/POLYMER CEMENTED

Catalog Number	320-15-01
Medical Device Problem Code	Migration (4003)
Health Effect - Clinical Code	Pain (1994)
Date of Event	10/16/2024
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that a 74 yo female patient, initial left shoulder implanted in (b)(6) 2015, underwent a revision procedure in (b)(6) 2024, approximately 9 years 4 months post the initial procedure.The patient complained about some mild pain in their shoulder.The surgeon obtained a ct which confirmed remodelling of the glenoid with the component migrating medially and superiorly.The first stage revision was completed with the stem left insitu.A replicator plate and antibacterial spacer were used to combat any potential infection.There were no surgical delays or device breakages during the procedure.The patient was last known to be in stable condition following the event.X-rays were not available.The explanted devices are not available for return, they were sent to rph for study.Device images were provided.No further information.
Additional Manufacturer Narrative
D10: concomitants: 300-01-11 humeral stem, 11mm (b)(6).320-02-38 expanded glenosphere, 38mm, +4mm (b)(6).320-10-00 humeral adapter tray, +0 (b)(6).320-15-01 glenoid plate (b)(6).320-15-05 glenosphere locking screw (b)(6).320-20-00 torque defining screw kit (b)(6).320-20-18 compression screw, 4.5 x 18mm, white (b)(6).320-20-18 compression screw, 4.5 x 18mm, white (b)(6).320-20-22 compression screw, 4.5 x 22mm, black (b)(6).320-20-26 compression screw, 4.5 x 26mm, orange (b)(6).320-20-46 compression screw, 4.5 x 46mm, purple (b)(6).320-38-00 humeral liner, 38mm, +0 (b)(6).
Additional Manufacturer Narrative
"this follow-up report is being submitted to relay additional and/or corrected information.The revision reported may be the result of glenoid loosening and prosthesis wear over the course of 9.5 years of implantation.However, the glenoid loosening cannot be confirmed and the underlying reason and/or any contributing factors to the event cannot be confirmed as the devices were not returned for evaluation and radiographs were not provided.If any further information is obtained that would change or alter any information provided, a supplemental report will be filed accordingly.".

• Brand Name: EQ REV GLENOID PLATE
• Common Device Name: PROSTHESIS, SHOULDER, NON-CONSTRAINED, METAL/POLYMER CEMENTED
• Manufacturer (Section D): EXACTECH, INC.; 2320 nw 66 court; gainesville FL 32653
• Manufacturer (Section G): EXACTECH, INC.; 2320 nw 66 court; gainesville FL 32653
• Manufacturer Contact: geoff gannon ; 2320 nw 66 court; gainesville, FL 32653 ; 3525541928
• MDR Report Key: 20501672
• Report Number: 1038671-2024-04064
• Device Sequence Number: 20730234
• Product Code: KWT
• UDI-Device Identifier: 10885862086488
• UDI-Public: 10885862086488
• Combination Product (Y/N): N
• Initial Reporter Country: AS
• PMA/510(K) Number: K063569
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2015
• Device Explanted Year: 2024
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Consumer,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 02/06/2025

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
• Operator of Device: Health Professional
• Device Expiration Date: 09/24/2024
• Device Catalogue Number: 320-15-01
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/16/2024
• Supplement Date Received by Manufacturer: 01/30/2025
• Initial Report FDA Received Date: 10/22/2024
• Supplement Report FDA Received Date: 02/06/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 09/26/2014
• 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: A
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SEE H11.
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 74 YR
• Patient Sex: Female