MAUDE Adverse Event Report: ARTHREX, INC. BIOCOMPOSITE INTER- FERENCE SCREW; FASTENER, FIXATION, BIODEGRADABLE, SOFT TISSUE

Model Number	BIOCOMPOSITE INTER- FERENCE SCREW
Health Effect - Clinical Code	Foreign Body Reaction (1868)
Date of Event	12/19/2016
Type of Reportable Event	Serious Injury
Additional 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.
Event or Problem Description
It was reported that the screw was implanted on (b)(6) 2016 during an acl procedure into the tibia.The patient developed an inflammation reaction in the tibia after the acl procedure.The screw remains in the patient.No more information has been made available.

• Brand Name: BIOCOMPOSITE INTER- FERENCE SCREW
• Common Device Name: FASTENER, FIXATION, BIODEGRADABLE, SOFT TISSUE
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• MDR Report Key: 10784224
• Report Number: 1220246-2020-02300
• Device Sequence Number: 2904119
• Product Code: MAI
• UDI-Device Identifier: 00888867016163
• UDI-Public: 00888867016163
• Combination Product (Y/N): N
• Initial Reporter Country: SZ
• PMA/510(K) Number: K071176
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: foreign,health professional,u
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 11/04/2020

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
• Operator of Device: Health Professional
• Device Expiration Date: 05/31/2018
• Device Model Number: BIOCOMPOSITE INTER- FERENCE SCREW
• Device Catalogue Number: AR-1400C
• Device Lot Number: 10050252
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/08/2020
• Initial Report FDA Received Date: 11/04/2020
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other