MAUDE Adverse Event Report: ARTHREX, INC. SUTURE ANCHOR, BIO- CORKSCREW FT, VENTED; SCREW, FIXATION, BONE

Model Number	SUTURE ANCHOR, BIO- CORKSCREW FT, VENTED
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/06/2021
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.If the device becomes available for evaluation, a follow-up report will be submitted.
Event or Problem Description
It was reported that during shoulder arthroscopy surgery the anchor has been rotated 2x for insertion and then the tip broke off.The broken off piece has been retrieved from the patient.There was no harm for patient, operator or third party reported.The surgery was finished successfully with a new device with the same part number.It was not necessary to switch the surgical technique or do a second surgery.No further information received.
Additional Manufacturer Narrative
Complaint confirmed, the anchor proximal end fragment was returned and measures approximately 3/8 in.No abnormality observed on the driver.The anchor fragment is wrapped and could not be measured.Likely causes of the event include improper bone prep; misaligned insertion; prying/leveraging the device during insertion.

• Brand Name: SUTURE ANCHOR, BIO- CORKSCREW FT, VENTED
• Common Device Name: SCREW, FIXATION, BONE
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• MDR Report Key: 12231690
• Report Number: 1220246-2021-03439
• Device Sequence Number: 4991537
• Product Code: HWC
• UDI-Device Identifier: 00888867023451
• UDI-Public: 00888867023451
• Combination Product (Y/N): N
• Initial Reporter Country: GM
• PMA/510(K) Number: K061863
• 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,Followup
• Report Date (Section B): 08/20/2021

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
• Operator of Device: Health Professional
• Device Model Number: SUTURE ANCHOR, BIO- CORKSCREW FT, VENTED
• Device Catalogue Number: AR-1927BFC
• Device Lot Number: 12089563
• Was Device Available for Evaluation?: Yes
• Initial Date Received by Manufacturer: 07/08/2021
• Supplement Date Received by Manufacturer: 07/08/2021
• Initial Report FDA Received Date: 07/27/2021
• Supplement Report FDA Received Date: 08/20/2021
• Patient Sequence Number: 1