MAUDE Adverse Event Report: ARTHREX, INC. PNCH, WB 15 UP TP, 3.4 STR, W/FLUSHPORT; ACCESSORIES, ARTHROSCOPIC

Model Number	PNCH, WB 15 UP TP, 3.4 STR, W/FLUSHPORT
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/23/2021
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 meniscal resection the tip broke.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
The complaint is confirmed.One unpackaged ar-12240f, batch 10464514 was received for investigation.Functional testing identified that jaws at the distal tip were unable to be actuating when the handle assembly was engaged, indicating that the shear pin within the handle had broken.The observed condition is consistent with excessive force applied when engaging the handle.However, visual inspection concluded without the observance of breakage at the tip.The distal end of the device remained intact, although it was non-functional.

• Brand Name: PNCH, WB 15 UP TP, 3.4 STR, W/FLUSHPORT
• Common Device Name: ACCESSORIES, ARTHROSCOPIC
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• MDR Report Key: 12658442
• Report Number: 1220246-2021-03799
• Device Sequence Number: 17263343
• Product Code: NBH
• UDI-Device Identifier: 00888867252493
• UDI-Public: 00888867252493
• Combination Product (Y/N): N
• Initial Reporter Country: LH
• 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,Followup
• Report Date (Section B): 10/28/2021

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: PNCH, WB 15 UP TP, 3.4 STR, W/FLUSHPORT
• Device Catalogue Number: AR-12240F
• Device Lot Number: 10464514
• Was Device Available for Evaluation?: Yes
• Initial Date Received by Manufacturer: 09/28/2021
• Supplement Date Received by Manufacturer: 09/28/2021
• Initial Report FDA Received Date: 10/19/2021
• Supplement Report FDA Received Date: 10/28/2021
• Patient Sequence Number: 1