MAUDE Adverse Event Report: LIMACORPORATE S.P.A SMR SHOULDER; REVERSE RETENTIVE LINER 40MM +6MM

Model Number	1365.50.821
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	Joint Dislocation (2374)
Date of Event	02/17/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Explanted components have been discarded therefore cannot be returned to manufacturer for identification and analysis.No review of manufacturing records for complained parts can be performed either since lot number is unknown.No x-rays nor pictures of explanted components were provided either.From follow-up communication with complaint source it was confirmed that no further information regarding the case can be retrieved, therefore no further root cause investigation is possible.Taking into account the involved product family smr shoulder, no adverse trend has been identified for reported issue in the last year.According to investigation carried out, no corrective action is needed for this event.If any additional information is received that would change or alter any conclusion, a supplemental report will be filed accordingly.The manufacturer will continue monitoring the market in order to detect any similar event.
Event or Problem Description
Revision surgery was performed on (b)(6) 2025 due to shoulder dislocation.Previous surgery is unknown, as well as complete product information of original implant.During revision the surgeon removed the pre-existing smr reverse components: tt augm.360 baseplate #s-r 7° (part number 1375.15.507).Smr glenoid peg tt small-r #m (part number 1375.14.652) smr glenosphere ø 40mm (part number 1374.09.121) smr reverse liner retentive (part number 1365.50.821).The assembly has then been converted to an anatomic configuration implanting an extension for humeral reverse body (part number 1352.15.001), an adaptor 36mm for reverse body (part number 1352.15.200) and a cta head dia 54mm (part number 1323.09.540).Surgery has been completed as intended.The patient is male, date of birth (b)(6) 1950.The event occurred in the united states.

• Brand Name: SMR SHOULDER
• Common Device Name: REVERSE RETENTIVE LINER 40MM +6MM
• Manufacturer (Section D): LIMACORPORATE S.P.A; via nazionale 52; villanova di san daniele, udine 33038 ; IT 33038
• Manufacturer Contact: via nazionale 52; villanova di san daniele, udine 33038
• MDR Report Key: 24201306
• Report Number: 3008021110-2026-00077
• Device Sequence Number: 14830074
• Product Code: PHX
• UDI-Device Identifier: 08033390102971
• UDI-Public: 8033390102971
• Combination Product (Y/N): N
• PMA/510(K) Number: K142139
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 01/28/2026

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?: No
• Device Model Number: 1365.50.821
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 01/28/2026
• 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