MAUDE Adverse Event Report: ARTHREX, INC. SUTURE ANCHOR, BIOCOMPOSITE CORKSCREW; FASTENER, FIXATION, BIODEGRADABLE, SOFT TISSUE

Model Number	SUTURE ANCHOR, BIOCOMPOSITE CORKSCREW
Health Effect - Clinical Code	Foreign Body In Patient (2687)
Date of Event	06/22/2021
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 a surgery the anchor broke off inside the patient when screwing in the humerus to secure the sutures of the cap repair assembly.No harm for patient, operator or third party was 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.

• Brand Name: SUTURE ANCHOR, BIOCOMPOSITE CORKSCREW
• Common Device Name: FASTENER, FIXATION, BIODEGRADABLE, SOFT TISSUE
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• MDR Report Key: 12467461
• Report Number: 1220246-2021-03644
• Device Sequence Number: 19810191
• Product Code: MAI
• UDI-Device Identifier: 00888867096790
• UDI-Public: 00888867096790
• Combination Product (Y/N): N
• Initial Reporter Country: FR
• PMA/510(K) Number: K082810
• 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): 09/14/2021

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 Expiration Date: 06/30/2024
• Device Model Number: SUTURE ANCHOR, BIOCOMPOSITE CORKSCREW
• Device Catalogue Number: AR-1927BCF-3-1
• Device Lot Number: 11394735
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/26/2021
• Initial Report FDA Received Date: 09/14/2021
• Patient Sequence Number: 1