MAUDE Adverse Event Report: ENCORE MEDICAL L.P. TURON SHOULDER; TURON PEGGED GLENOID IMPLANT, SIZE 42

Model Number	520-01-242
Health Effect - Clinical Codes	Failure of Implant (1924); No Code Available (3191)
Date of Event	11/20/2017
Type of Reportable Event	Serious Injury
Event or Problem Description
Revision surgery - due to the glenoid components coming loose over time.The patient had a total shoulder arthroplasty (tsa) procedure in 2012.The surgeon removed the original components and converted to a reverse shoulder prosthesis (rsp).
Additional Manufacturer Narrative
The reason for this revision surgery was the glenoid components came loose.The in-vivo length of patient service for the implant was 5 years.There is no information in this complaint about any patient injuries, activities, or accidents that may have contributed to the need for this revision surgery.There are no reported pre-existing patient health conditions.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 implant device history records (dhr), shows that the reported component(s) used in the previous surgery met design and manufacturing requirements.There were no ncmrs associated with the product(s) that may have contributed to the reported event.The device and its applicable concomitant devices were verified to have gone through acceptable sterilization processes and were within their respective expiration dates at the time of use during the previous surgery.Customer complaint history of the reported device(s) showed no present trends or on-going issues that are in need of review.This event is deemed to be non-product related.The root cause of this complaint was a revision surgery due to the components becoming loose.No information was submitted with the complaint regarding pre-existing conditions of the patient or any activities the patient was involved in that may have contributed to the event.There are multiple factors that may contribute to an event that are outside of the control of djo surgical.Inventory containment is not required as there are no indications of a product or process issue affecting implant safety or effectiveness.

• Brand Name: TURON SHOULDER
• Common Device Name: TURON PEGGED GLENOID IMPLANT, SIZE 42
• Manufacturer (Section D): ENCORE MEDICAL L.P.; 9800 metric blvd.; austin TX 78758 5445
• MDR Report Key: 7088777
• Report Number: 1644408-2017-01113
• Device Sequence Number: 16510545
• Product Code: KWS
• UDI-Device Identifier: 00888912024952
• UDI-Public: (01)00888912024952
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K123982
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2012
• Device Explanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 01/08/2018

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
• Operator of Device: Health Professional
• Device Expiration Date: 05/28/2017
• Device Model Number: 520-01-242
• Device Catalogue Number: 520-01-242
• Device Lot Number: 191G1033
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 11/20/2017
• Supplement Date Received by Manufacturer: 01/02/2018
• Initial Report FDA Received Date: 12/06/2017
• Supplement Report FDA Received Date: 01/08/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: 520-00-000, LOT 878C1123; 520-01-010, LOT 455G1051; 520-42-016, LOT 909C1017
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 84 YR