MAUDE Adverse Event Report: SMITH & NEPHEW, INC. MICRPTR RGNSRB STR ANCHR W/1ULTRBRDSTRBL; FASTENER, FIXATION, BIODEGRADABLE, SOFT TISSUE

Model Number	72204983
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Codes	Perforation (2001); Rupture (2208); No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/25/2022
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that during a labrum repair procedure, a microraptor regenesorb anchor broke at proximal 1/3 of the anchor when tying knots over the tissue.The surgeon had to revert to mitek gryphon anchor and arthrex pushloc to secure the loose threads in the labrum, drilling new bone holes.The anchor bit were removed from the patient and a surgical delay greater than 60 minutes was reported.Small void was left in the patient.No other complications were reported.
Additional Manufacturer Narrative
Internal complaint reference case (b)(4).
Additional Manufacturer Narrative
Internal complaint reference (b)(4).The reported device was not returned to the designated complaint unit for independent evaluation, thus visual inspection and functional testing could not be performed.A review of device records showed there were no indications to suggest that the product did not meet manufacturing specifications upon release for distribution.A complaint history review found no similar reported events.The instructions for use were reviewed and found to include conditions of off label use and technique specifics, as well as precautions and warnings related to the use of the device.A risk management review found that the reported failure and/or harm was documented appropriately, and there were no indications to suggest the anticipated risk is not adequate.A review of the drawing found the raw material must comply with specifications.No relevant clinical information nor the device has been provided, therefore, a thorough medical investigation cannot be rendered nor can the clinical root cause of the reported failure be determined.Based on the information provided on the customer feed-back form, the surgeon used a change in surgical technique to complete the procedure by using a competitor¿s device to secure the loose threads in the labrum, drilling new bone holes.According to the report, the anchors bits were removed from inside of the patient with a surgical delay of greater than an hour leaving a small void in the patient.Since no other complications were reported, no further clinical/medical assessment is warranted at this time.There was no relationship found between the device and the reported event.The complaint was not confirmed.Please refer to the instructions for use for recommendations on proper use of the device and potential troubleshooting methods to prevent future reoccurrence of the reported event.No containment or corrective actions are recommended at this time.If the product associated with this event is returned at a future date, this investigation will be reopened for evaluation.

• Brand Name: MICRPTR RGNSRB STR ANCHR W/1ULTRBRDSTRBL
• Common Device Name: FASTENER, FIXATION, BIODEGRADABLE, SOFT TISSUE
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 76 s. meridian ave.; oklahoma city OK 73107
• Manufacturer (Section G): SMITH & NEPHEW, INC.; 76 s. meridian ave.; oklahoma city OK 73107
• Manufacturer Contact: holly topping ; 7000 west william cannon drive; austin, TX 78735 ; 5123913905
• MDR Report Key: 13529206
• Report Number: 1643264-2022-00047
• Device Sequence Number: 5515138
• Product Code: MAI
• UDI-Device Identifier: 00885556710302
• UDI-Public: 00885556710302
• Combination Product (Y/N): N
• Initial Reporter Country: NZ
• PMA/510(K) Number: K180361
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,Health Professional,User Facility,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/29/2022

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: 01/12/2024
• Device Model Number: 72204983
• Device Catalogue Number: 72204983
• Device Lot Number: 2065874
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/25/2022
• Supplement Date Received by Manufacturer: 11/28/2022
• Initial Report FDA Received Date: 02/14/2022
• Supplement Report FDA Received Date: 11/29/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 01/12/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown