MAUDE Adverse Event Report: SMITH & NEPHEW, INC. VAS HD AC 4MM X 70 DEG; ARTHROSCOPE

Model Number	72202958
Medical Device Problem Codes	Break (1069); Optical Distortion (3000); Optical Obstruction (3002); Scratched Material (3020)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/27/2022
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that during an arthroscopy procedure, the line (marked in red circle) of the scope bellow the autoclavable was loosen which caused blurry definition in monitor.The procedure was finished with a delay greater than 30 minutes using the same device.No patient complications were reported.
Additional Manufacturer Narrative
(b)(4).
Additional Manufacturer Narrative
H6: the reported device was received for evaluation.A visual inspection of returned device found distal tip damage, broken lens, image cloudy and scratches on the needle.The reported malfunction was duplicated during functional testing.These failures have been determined to be related to the reported event.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 similar reported events.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.The root cause was associated with an unintended use of the device.Factors that could have contributed to the reported event include an impact event inconsistent with normal use.No containment or corrective actions are recommended at this time.

• Brand Name: VAS HD AC 4MM X 70 DEG
• Common Device Name: ARTHROSCOPE
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 150 minuteman road; andover MA 01810
• Manufacturer (Section G): SMITH & NEPHEW, INC.; 150 minuteman road; andover MA 01810
• Manufacturer Contact: holly topping ; 7000 west william cannon drive; austin, TX 78735 ; 5123913905
• MDR Report Key: 13691564
• Report Number: 3003604053-2022-00007
• Device Sequence Number: 13939078
• Product Code: HRX
• UDI-Device Identifier: 00885554018776
• UDI-Public: 00885554018776
• Combination Product (Y/N): N
• Initial Reporter Country: KS
• PMA/510(K) Number: K043395
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,User Facility,Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 04/08/2024

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: 72202958
• Device Catalogue Number: 72202958
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/15/2022
• Supplement Date Received by Manufacturer: 04/04/2024
• Initial Report FDA Received Date: 03/08/2022
• Supplement Report FDA Received Date: 04/08/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Male