MAUDE Adverse Event Report: ARTHREX, INC. DW OUTFLOW CASSETTE/TUBE SET; ARTHROSCOPE

Model Number DW OUTFLOW CASSETTE/TUBE SET

Device Problem Excess Flow or Over-Infusion (1311)

Patient Problem Swelling/ Edema (4577)

Event Date 10/04/2021

Event Type  Injury  

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 Description

It was reported that during a shoulder arthroscopy the shoulder swelled very much.There was no harm for patient, operator or third party reported.The surgery was finished successfully with the same device anyway.It was not necessary to switch the surgical technique or do a second surgery.12-oct-2021 update dw: further information was provided that during the surgery the pump delivered more fluid than expected and an ar-6420 and ar-6430 was used but then discarded.The pump setting was set to 50mmhg and no alarm/error messages occurred during use.The surgeon was able to improve the outcome by lowering the pressure to 40/45mmhg.It was further reported that the liquid was immediately removed with the use of a cannula.A clamp test was not performed.

• Brand Name: DW OUTFLOW CASSETTE/TUBE SET
• Type of Device: ARTHROSCOPE
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• MDR Report Key: 12697547
• MDR Text Key: 278524874
• Report Number: 1220246-2021-03852
• Device Sequence Number: 1
• Product Code: HRX
• UDI-Device Identifier: 00888867039322
• UDI-Public: 00888867039322
• Combination Product (y/n): N
• PMA/PMN Number: K083707
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Type of Report: Initial
• Report Date: 10/26/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/26/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: DW OUTFLOW CASSETTE/TUBE SET
• Device Catalogue Number: AR-6430
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 10/08/2021
• Is the Device Single Use?: Yes
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Other