MAUDE Adverse Event Report: ENCORE MEDICAL L.P. DJO SURGICAL; UNKNOWN POLY PART

Catalog Number	UNKNOWN
Medical Device Problem Code	Naturally Worn (2988)
Health Effect - Clinical Code	Joint Laxity (4526)
Date of Event	06/11/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery - due to poly wear.
Additional Manufacturer Narrative
It was reported as, revision surgery: "cuff failure and poly wear - converted to reverse" the actual length of in-vivo for the item listed is unknown as the original surgery date was not provided or could be established.Item number: unk-surg, item description: unknown part for surgical, lot number: unknown, part revision: na, product type: shoulder, manufacture date: unknown, expiration date: unknown.This investigation is limited in scope as only partial information was provided to djo surgical - austin for review.The revised item was not returned for examination and the item and or lot number was not provided.To adequately investigate this event, the part and lot numbers are necessary.If this information is submitted at a future date, this investigation will be re-evaluated.There was no information submitted with this complaint about any patient activities, accidents, or medical contraindications that may have contributed to the reported event.The surgeon performed this revision to remedy the patient's condition.This complaint will be closed pending receipt of additional information.No further action is deemed necessary at this time.

• Brand Name: DJO SURGICAL
• Common Device Name: UNKNOWN POLY PART
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd.; austin TX 78758
• Manufacturer (Section G): ENCORE MEDICAL L.P.; 9800 metric blvd.; austin TX 78758
• Manufacturer Contact: stacey bonnell ; 9800 metric blvd.; austin, TX 78758
• MDR Report Key: 25660427
• Report Number: 1644408-2026-01278
• Device Sequence Number: 20259060
• Product Code: KWS
• UDI-Device Identifier: 00888912118903
• UDI-Public: 00888912118903
• Combination Product (Y/N): N
• Initial Reporter State: NY
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 06/29/2026

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 Catalogue Number: UNKNOWN
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/11/2026
• Initial Report FDA Received Date: 06/29/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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
• Concomitant Medical Products and Therapy/Usage Dates: UNK-SURG LOT: UNKNOWN.; UNK-SURG LOT: UNKNOWN.
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown