inforMED
InjuryPHX

SHOULDER SYSTEM

Received Jul 8, 2026 · Event occurred Jun 17, 2026

Report 3005180920-2026-00654 · MDR key 25747718

Device

Generic name

Humeral Reverse Metaphysis +0mm/0°

Model number

04.01.0110

Lot number

2003900

Product problems

  • Adverse Event Without Identified Device or Use Problem

Patient

NA · Unknown

  • Implant Pain

Narrative

Additional Manufacturer Narrative

BATCH REVIEW PERFORMED ON 23 JUNE 2026 REVERSE SHOULDER SYSTEM 04.01.0110 HUMERAL REVERSE METAPHYSIS +0MM/0° (K170452) LOT 2003900: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 01-APR-2021. EXPIRATION DATE: 22-MAR-2026. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, ALL ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. REVERSE SHOULDER SYSTEM 04.01.0122 HUMERAL REVERSE HC LINER D 39/+0MM (K170452) LOT 2103241: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 02-JUN-2021. EXPIRATION DATE: 18-MAY-2026. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, ALL ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. REVERSE SHOULDER SYSTEM 04.01.0122 HUMERAL REVERSE HC LINER D 39/+0MM (K171058) LOT 2006953: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 23-NOV-2020. EXPIRATION DATE: 13-OCT-2025. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, ALL ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. REVERSE SHOULDER SYSTEM 04.01.0208 LAT. GLENOSPHERE 39XD 24.5 (K193175) LOT 2004003: (B)(4) ITEMS MANUFACTURED AND RELEASED ON 25-MAR-2021. EXPIRATION DATE: 16-MAR-2026. NO ANOMALIES FOUND RELATED TO THE PROBLEM. TO DATE, (B)(4) ITEMS OF THE SAME LOT HAVE BEEN SOLD WITH NO SIMILAR REPORTED EVENT DURING THE PERIOD OF REVIEW. ROOT CAUSE:BASED ON THE INFORMATION AVAILABLE NO DEFINITIVE ROOT CAUSE CAN BE ESTABLISHED, WHILE THERE IS NO INDICATION THAT ANY POTENTIAL ISSUE WITH THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT, AND THE DEVICE HISTORY RECORD REVIEW DOES NOT INDICATE ANY POTENTIAL MANUFACTURING RELATED ISSUE.

Description of Event or Problem

THE PATIENT CAME IN PRESENTING CHRONIC PAIN AND THE CAUSE IS UNKNOWN. THERE WERE NO INDICATIONS OF TRAUMA. ABOUT 4 YEARS AND 7 MONTHS AFTER THE PRIMARY SURGERY, THE SURGEON REVISED ALL COMPONENTS EXCEPT THE DIAPHYSIS.