MAUDE Adverse Event Report: ARTHREX, INC. ANTEGRADE TARGETING MODULE; MANUAL INSTR, GENERAL SURGICAL

Model Number ANTEGRADE TARGETING MODULE

Device Problem Device Damaged by Another Device (2915)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 07/13/2023

Event Type  malfunction  

Manufacturer Narrative

The contribution of the device to the reported event could not be determined as the device was not returned for evaluation.The root cause of the event could not be determined from the information available and without device evaluation.If the device becomes available for evaluation, a follow-up report will be submitted.

Event Description

On (b)(6)2023, it was reported by a sales representative via sems that a 1271-200 antegrade targeting module broke during a case.The instrument cracked while the surgeon was malleting the impactor pad.This was discovered during an unspecified procedure, with no patient harm reported.

• Brand Name: ANTEGRADE TARGETING MODULE
• Type of Device: MANUAL INSTR, GENERAL SURGICAL
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer (Section G): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer Contact: emily shafer ; 8009337001
• MDR Report Key: 17566542
• MDR Text Key: 321646749
• Report Number: 1220246-2023-07534
• Device Sequence Number: 1
• Product Code: LXH
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Distributor
• Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial
• Report Date: 08/17/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/17/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: ANTEGRADE TARGETING MODULE
• Device Catalogue Number: 1271-200
• Device Lot Number: 140665
• Was Device Available for Evaluation?: Yes
• Date Manufacturer Received: 07/13/2023
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1