MAUDE Adverse Event Report: ARTHREX, INC. SUTR ANCH HIP PEEK P-LCK 2.9X12.5MM; BIO SOFT TISSUE FIXATN FASTNR

Model Number SUTR ANCH HIP PEEK P-LCK 2.9X12.5MM

Device Problem Device Dislodged or Dislocated (2923)

Patient Problem Insufficient Information (4580)

Event Date 11/08/2023

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 11/23/2023, it was reported by an arthrex subsidiary employee via (b)(4), that an ar-2923phs suture anchor peek hip pushlock anchor backed out.This occurred during a hip arthroscopy procedure on 11/08/2023 the material was safely removed and reassembled with the correct position and used to successfully complete the case.

• Brand Name: SUTR ANCH HIP PEEK P-LCK 2.9X12.5MM
• Type of Device: BIO SOFT TISSUE FIXATN FASTNR
• 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: 18369037
• MDR Text Key: 331333169
• Report Number: 1220246-2023-09541
• Device Sequence Number: 1
• Product Code: MAI
• UDI-Device Identifier: 00888867195837
• UDI-Public: 00888867195837
• Combination Product (y/n): N
• Reporter Country Code: CI
• PMA/PMN Number: K101679
• 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: 12/20/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: SUTR ANCH HIP PEEK P-LCK 2.9X12.5MM
• Device Catalogue Number: AR-2923PHS
• Device Lot Number: 14983332
• Was Device Available for Evaluation?: Yes
• Initial Date Manufacturer Received: 11/22/2023
• Initial Date FDA Received: 12/20/2023
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 07/20/2022
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1