| Brand Name | COMPREHENSIVE REVERSE SHOULDER REAMER GUIDE |
| Common Device Name | SHOULDER PROSTHESIS, REVERSE CONFIGURATION |
| Manufacturer (Section D) |
| ZIMMER BIOMET, INC. |
| 56 e. bell drive |
| p.o. box 587 |
| warsaw IN 46581 |
|
| Manufacturer (Section G) |
| ZIMMER BIOMET, INC. |
| 56 e. bell drive |
| p.o. box 587 |
| warsaw IN 46581 |
|
| Manufacturer Contact |
|
jennifer
rapsavage
|
| 56 e. bell dr. |
| warsaw, IN 46582
|
|
5745260384
|
|
| MDR Report Key | 24178163 |
| Report Number | 0001825034-2026-00200 |
| Device Sequence Number | 9557343 |
| Product Code |
PHX
|
| UDI-Device Identifier | 00887868254536 |
| UDI-Public | (01)00887868254536(11)240311(10)65699571 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MO |
| Initial Reporter Country | US |
| PMA/510(K) Number | K172502 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | Unknown |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Distributor |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
06/24/2026 |
| 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 Catalogue Number | 110040210 |
| Device Lot Number | 65699571 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 01/16/2026 |
| 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 | 01/05/2026 |
| Supplement Date Received by Manufacturer | 06/24/2026
|
| Initial Report FDA Received Date | 01/26/2026 |
| Supplement Report FDA Received Date | 06/25/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 03/11/2024 |
| Is the Device Labeled for Single Use? (Y/N) |
No
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Reuse
|
If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement | NI |
| Patient Sequence Number | 1 |
| Patient Age | 57 YR |
| Patient Sex | Male |