MAUDE Adverse Event Report: STRYKER GMBH GLENOSPHERE - 36MM DIA X 6MM THK CONCENTRIC; PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED

Catalog Number	5573-C-3606
Health Effect - Clinical Codes	Toxicity (2333); Osteolysis (2377)
Date of Event	05/14/2019
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Device was not returned.If additional information becomes available, it will be provided in a supplemental report.Device disposition unknown.
Event or Problem Description
The peripheral screws completely disassociated from the glenoid baseplate, even with the glenosphere intact.There was significant bone loss on the glenoid, and the micromotion from the baseplate & screws "rocking" left uncontained defects in the glenoid.There was metallosis around the implants and osteolysis around the humeral cup.Revision surgery occurred.
Event or Problem Description
The peripheral screws completely disassociated from the glenoid baseplate, even with the glenosphere intact.There was significant bone loss on the glenoid, and the micromotion from the baseplate & screws "rocking" left uncontained defects in the glenoid.There was metallosis around the implants and osteolysis around the humeral cup.Revision surgery occurred.
Additional Manufacturer Narrative
Investigation revealed the subject product to be a concomitant item.The device did not contribute to the reported event.If any additional information is provided indicating otherwise the record will be reopened and the investigation will be reworked.

• Brand Name: GLENOSPHERE - 36MM DIA X 6MM THK CONCENTRIC
• Common Device Name: PROSTHESIS, SHOULDER, SEMI-CONSTRAINED, METAL/POLYMER CEMENTED
• Manufacturer (Section D): STRYKER GMBH; bohnackerweg 1; postfach; selzach 2545 ; CH 2545
• MDR Report Key: 8680335
• Report Number: 0008031020-2019-00531
• Device Sequence Number: 2232890
• Product Code: KWS
• UDI-Device Identifier: 07613327098891
• UDI-Public: 07613327098891
• Combination Product (Y/N): N
• Initial Reporter State: NV
• Initial Reporter Country: US
• PMA/510(K) Number: K130895
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2019
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 08/26/2019

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?: Yes
• Operator of Device: Lay User/Patient
• Device Catalogue Number: 5573-C-3606
• Device Lot Number: K96X3X
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 05/14/2019
• Supplement Date Received by Manufacturer: 07/30/2019
• Initial Report FDA Received Date: 06/07/2019
• Supplement Report FDA Received Date: 08/26/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 60 YR