MAUDE Adverse Event Report: ARTHREX, INC. AUTOLOGOUS TISSUE COLLECTOR; ACCESSORIES, ARTHROSCOPIC

Model Number AUTOLOGOUS TISSUE COLLECTOR

Device Problem Defective Device (2588)

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

Event Date 01/19/2022

Event Type  Injury  

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 autocart procedure no thrombin was produced.The mixture could not be produced because the thrombin could not be drawn from the filter.There was no harm for patient, operator or third party.The surgery was finished successfully by doing a pridie drilling.It was not necessary do a second surgery.

• Brand Name: AUTOLOGOUS TISSUE COLLECTOR
• Type of Device: ACCESSORIES, ARTHROSCOPIC
• 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: vik bajnath ; 8009337001
• MDR Report Key: 13472059
• MDR Text Key: 285218086
• Report Number: 1220246-2022-04426
• Device Sequence Number: 1
• Product Code: NBH
• UDI-Device Identifier: 00888867306189
• UDI-Public: 00888867306189
• 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,Health Professional,User Facility
• Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date: 02/07/2022

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
• Device Operator: Health Professional
• Device Model Number: AUTOLOGOUS TISSUE COLLECTOR
• Device Catalogue Number: ABS-1050
• Device Lot Number: 1187113713
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 01/19/2022
• Initial Date FDA Received: 02/07/2022
• Date Device Manufactured: 07/01/2021
• Is the Device Single Use?: Yes
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Other