MAUDE Adverse Event Report: ARTHREX, INC. PIN DRIVER ATTACHMENT 0.8-4.0 MM; INSTRUMENT, SURGICAL, ORTHOPEDIC, AC-POWERED MOTOR AND ACCESSORY/ATTACHMENT

Model Number	PIN DRIVER ATTACHMENT 0.8-4.0 MM
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/04/2022
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 recon procedure the device pulled out bits of the wires.No part of the device broke off.According to the surgeon no harm for patient, operator or third party occurred.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.Update 17-feb-2022: it was confirmed that the guide wires were torn.
Additional Manufacturer Narrative
The reported event was confirmed as the suppliers evaluation revealed a broken anti-rotation pin between connector and outer sleeve which allows the attachment to rotate.The attachment was produced in 2017 and therefore 5 years in use.Considering the age of the device, the reported event is most likely due to wear and tear.

• Brand Name: PIN DRIVER ATTACHMENT 0.8-4.0 MM
• Common Device Name: INSTRUMENT, SURGICAL, ORTHOPEDIC, AC-POWERED MOTOR AND ACCESSORY/ATTACHMENT
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer (Section G): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer Contact: vik bajnath ; 8009337001
• MDR Report Key: 13621341
• Report Number: 1220246-2022-04541
• Device Sequence Number: 5289049
• Product Code: HWE
• UDI-Device Identifier: 00888867110977
• UDI-Public: 00888867110977
• Combination Product (Y/N): N
• Initial Reporter Country: KE
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Company Representative
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup
• Report Date (Section B): 05/16/2022

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
• Device Model Number: PIN DRIVER ATTACHMENT 0.8-4.0 MM
• Device Catalogue Number: AR-600PD-3
• Device Lot Number: 10144565
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/09/2022
• Supplement Date Received by Manufacturer: 02/09/2022
• Initial Report FDA Received Date: 02/28/2022
• Supplement Report FDA Received Date: 05/16/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is the Device Labeled for Single Use? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown