MAUDE Adverse Event Report: ENCORE MEDICAL L.P RSP SHOULDER; BASEPLATE, GLENOID HA-COAT, RSP, 6.5MM X 30MM

Model Number 508-32-104

Device Problems Break (1069); Component Falling (1105)

Patient Problems Fall (1848); Bone Fracture(s) (1870)

Event Date 06/06/2017

Event Type  Injury  

Event Description

Revision surgery - due to the patient falling and breaking their glenoid bone.

Manufacturer Narrative

The reason for this revision surgery was a broken glenoid bone.The in-vivo length of patient service for the implant was 4.7 years.The healthcare professional indicated there was no delay in surgery and another suitable device was available for use.The revision surgery was completed as intended.The device was disposed of at the hospital and not made available to djo surgical for examination.A review of the device history records (dhrs) revealed no discrepancies or issues with the manufacturing of this part.All critical dimensions, design criteria and specifications in effect at the time the part was manufactured were met.The product complaint report history was reviewed and no trends or on-going issues were deemed as present or in need of review.This event is deemed as non-product related.The root cause for this event was the patient had fall and broke their glenoid bone.Inventory containment is not required since there are no indications of a product or process issue affecting implant safety or effectiveness.

Manufacturer Narrative

Correced data: concomitmant parts.

• Brand Name: RSP SHOULDER
• Type of Device: BASEPLATE, GLENOID HA-COAT, RSP, 6.5MM X 30MM
• Manufacturer (Section D): ENCORE MEDICAL L.P; 9800 metric blvd; austin TX 78758 5445
• Manufacturer (Section G): ENCORE MEDICAL L.P.; 9800 metric blvd.; austin TX 78758 5445
• Manufacturer Contact: teffany hutto ; 9800 metric blvd.; austin, TX 78758-5445
• MDR Report Key: 6691326
• MDR Text Key: 79227950
• Report Number: 1644408-2017-00535
• Device Sequence Number: 1
• Product Code: KWS
• UDI-Device Identifier: 00888912024754
• UDI-Public: (01)00888912024754
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K051075
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date: 09/14/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/06/2017
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 08/31/2018
• Device Model Number: 508-32-104
• Device Catalogue Number: 508-32-104
• Device Lot Number: 866C1361
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 08/18/2017
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 08/24/2012
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 68 YR