MAUDE Adverse Event Report: SMITH & NEPHEW, INC. PCH,BSKT,SCP,UPBTR,1.5MM; ACCESSORIES, ARTHROSCOPIC

Catalog Number 012020

Device Problems Break (1069); Detachment Of Device Component (1104)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 11/05/2012

Event Type  malfunction  

Manufacturer Narrative

Visual inspection and functional testing could not be performed because the device in question was not returned for evaluation.Thus, the complaint could not be verified, nor could the root cause be determined with confidence.There are no indications that would suggest the device did not meet product specifications upon release into distribution.

Event Description

During a left knee arthroscopy the tip of the metal arthroscopy instrument, accufex 1.5 mm upbitter linear punch broke off inside of the knee.The surgeon was able to retrieve the part and removed it from the knee.No patient injury or other complications were reported.

• Brand Name: PCH,BSKT,SCP,UPBTR,1.5MM
• Type of Device: ACCESSORIES, ARTHROSCOPIC
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 130 forbes boulevard; mansfield MA 02048
• Manufacturer (Section G): SMITH & NEPHEW, INC.; 130 forbes boulevard; mansfield MA 02048
• Manufacturer Contact: jim gonzales ; 150 minuteman road; andover, MA ; 5123585706
• MDR Report Key: 5961308
• MDR Text Key: 55384921
• Report Number: 1219602-2016-00701
• Device Sequence Number: 1
• Product Code: NBH
• 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: company representative,health
• Reporter Occupation: Health Professional
• Type of Report: Initial
• Report Date: 01/29/2013

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 Catalogue Number: 012020
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 01/29/2013
• Initial Date FDA Received: 09/19/2016
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: N
• Patient Sequence Number: 1