MAUDE Adverse Event Report: ARTHREX, INC. KINGFIR SUTR RETRVR /TISS GRSPR W/WB; MANUAL INSTR, GENERAL SURGICAL

Model Number KINGFIR SUTR RETRVR /TISS GRSPR W/WB

Device Problem Break (1069)

Patient Problem Insufficient Information (4580)

Event Date 02/16/2024

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 02/16/2024, it was reported by a distributor via (b)(4) that an ar-13970w suture retrievers clamp broke.This occurred during a case.No additional information was provided, and additional information has been asked.

• Brand Name: KINGFIR SUTR RETRVR /TISS GRSPR W/WB
• 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: jared engle ; 8009337001
• MDR Report Key: 18829999
• MDR Text Key: 337221980
• Report Number: 1220246-2024-01274
• Device Sequence Number: 1
• Product Code: NBH
• UDI-Device Identifier: 00888867015784
• UDI-Public: 00888867015784
• Combination Product (y/n): N
• Reporter Country Code: DR
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Distributor
• Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial
• Report Date: 03/04/2024

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: KINGFIR SUTR RETRVR /TISS GRSPR W/WB
• Device Catalogue Number: AR-13970W
• Device Lot Number: 11818633
• Was Device Available for Evaluation?: Yes
• Initial Date Manufacturer Received: 02/16/2024
• Initial Date FDA Received: 03/04/2024
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 10/08/2020
• 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