MAUDE Adverse Event Report: ARTHREX, INC. SUTRLASSO FOR HIP ARTHRSCPY,CRESCENT; ORTHOPEDIC MANUAL SURGICAL INSTRUMENT

Model Number	SUTRLASSO FOR HIP ARTHRSCPY,CRESCENT
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/02/2021
Type of Reportable Event	Malfunction
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 during a hip arthroscopic procedure, the ar-4068ch, nitinol broke when trying to recover, it was used on the opposite side, and it broke again.The case was completed by using another ar-4068ch without further issue.

• Brand Name: SUTRLASSO FOR HIP ARTHRSCPY,CRESCENT
• Common Device Name: ORTHOPEDIC MANUAL SURGICAL INSTRUMENT
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• MDR Report Key: 11553537
• Report Number: 1220246-2021-02781
• Device Sequence Number: 14303454
• Product Code: LXH
• UDI-Device Identifier: 00888867031562
• UDI-Public: 00888867031562
• Combination Product (Y/N): N
• Initial Reporter Country: MX
• 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: Administrator/Supervisor
• Type of Report: Initial
• Report Date (Section B): 03/23/2021

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: 01/31/2024
• Device Model Number: SUTRLASSO FOR HIP ARTHRSCPY,CRESCENT
• Device Catalogue Number: AR-4068CH
• Device Lot Number: 904490855
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/02/2021
• Initial Report FDA Received Date: 03/23/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1