MAUDE Adverse Event Report: ARTHROCARE CORP. DFP SUTURE PASSER STANDARD

Catalog Number	22-4039
Medical Device Problem Code	Firing Problem (4011)
Health Effect - Clinical Code	No Information (3190)
Date of Event	11/02/2020
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that during a rotator cuff repair procedure, the first pass could not retrieve the suture after firing was done also had difficulties in opening after the sure was deployed.Procedure was completed with a competitor device.No significant delay and no other complications were reported.All available information has been disclosed.If additional information should become available, a supplemental report will be submitted accordingly.
Additional Manufacturer Narrative
H10: h3,h6: the reported device, used in treatment, was not returned for evaluation.A relationship, if any, between the subject device and the reported event could not be determined.A review of the device history records for the device showed there were no indications to suggest that the product did not meet manufacturing specification or would not be able to perform as intended.A complaint history review concluded this was a repeat issue.Without the reported product a visual and functional evaluation cannot be performed and customer¿s complaint cannot be confirmed.Factors that could have contributed to the reported event include: (1) excessive force (2) tissue thickness.(3) damage or debris in the device tip between passes.There were no indications that would suggest that the device did not meet product specifications upon release into distribution.If the product associated with this event is returned at a future date, this evaluation will be reopened for investigation.

• Brand Name: DFP SUTURE PASSER STANDARD
• Common Device Name: PASSER
• Manufacturer (Section D): ARTHROCARE CORP.; 7000 w. william cannon; austin TX 78735
• MDR Report Key: 10880100
• Report Number: 3006524618-2020-01018
• Device Sequence Number: 16895363
• Product Code: HWQ
• UDI-Device Identifier: 00885556724552
• UDI-Public: 885556724552
• Combination Product (Y/N): N
• Initial Reporter Country: KE
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 01/04/2021

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 01/11/2023
• Device Catalogue Number: 22-4039
• Device Lot Number: 2047482
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 11/02/2020
• Supplement Date Received by Manufacturer: 12/31/2020
• Initial Report FDA Received Date: 11/20/2020
• Supplement Report FDA Received Date: 01/04/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention