MAUDE Adverse Event Report: ARTHREX, INC. PNCH, MD 15 UP TP, 3.4 STR, W/FLUSHPORT; ARTHROSCOPE AND ACCESSORIES

Model Number PNCH, MD 15 UP TP, 3.4 STR, W/FLUSHPORT

Device Problem Break (1069)

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

Event Date 11/21/2023

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

It was reported that during an anterior cruciate ligament surgery the shaft broke.There was no harm for patient, operator or third party reported.The surgery was finished successfully with a new device with the same part number.It was not necessary to switch the surgical technique or do a second surgery.Update dw 01-dec-2023 further information were provided that the broken pieces were retrieved out of the patient.

• Brand Name: PNCH, MD 15 UP TP, 3.4 STR, W/FLUSHPORT
• Type of Device: ARTHROSCOPE AND ACCESSORIES
• 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: 18360335
• MDR Text Key: 331301944
• Report Number: 1220246-2023-09498
• Device Sequence Number: 1
• Product Code: NBH
• UDI-Device Identifier: 00888867252516
• UDI-Public: 00888867252516
• Combination Product (y/n): N
• Reporter Country Code: GM
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Company Representative
• Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial
• Report Date: 12/19/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/19/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: PNCH, MD 15 UP TP, 3.4 STR, W/FLUSHPORT
• Device Catalogue Number: AR-12350F
• Was Device Available for Evaluation?: Yes
• Date Manufacturer Received: 11/21/2023
• Was Device Evaluated by Manufacturer?: No
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1