MAUDE Adverse Event Report: RIVERPOINT MEDICAL LLC JUGGERKNOT SOFT ANCHOR; BONE FIXATION FASTENER

Model Number	CM-99229B
Medical Device Problem Code	Device Handling Problem (3265)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/11/2022
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The product was not returned for evaluation.A review of the dhr for the lot was performed and not issues were noted during manufacturing and all finished goods testing requirements were met prior to lot release.Investigations performed did not reveal any issues with the product and the report could not be substantiated.This report and use of categorical definitions required by fda 3500a does not constitute an admission by riverpoint medical, or its employees have caused or contributed to the event described in this report.Riverpoint medical has filed this information to comply with the medical device reporting regulation 21 cfr part 803.If additional information is provided to riverpoint medical regarding this event, a supplementary 3500a form will be submitted as required by the fda.
Event or Problem Description
According to the reporter, "2.9 juggerknots were used with proper technique during the procedure.Each item attached failed to properly deploy when attempting to place anchor into the patient.Product failure during foot and ankle soft tissue repair (modified brostrum) and ankle syndesmosis on (b)(6) 2022".

• Brand Name: JUGGERKNOT SOFT ANCHOR
• Common Device Name: BONE FIXATION FASTENER
• Manufacturer (Section D): RIVERPOINT MEDICAL LLC; 825 ne 25th ave; portland OR 97232
• Manufacturer Contact: 825 ne 25th ave; portland, OR 97232
• MDR Report Key: 13564175
• Report Number: 3006981798-2022-00004
• Device Sequence Number: 4433090
• Product Code: MBI
• UDI-Device Identifier: 00810020087253
• UDI-Public: 00810020087253
• Combination Product (Y/N): N
• Initial Reporter State: CO
• Initial Reporter Country: US
• PMA/510(K) Number: K203740
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility,Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 02/18/2022

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: 01/28/2026
• Device Model Number: CM-99229B
• Device Lot Number: 21032224
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 02/02/2022
• Initial Report FDA Received Date: 02/18/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 03/22/2021
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown