MAUDE Adverse Event Report: ARTHREX, INC. ARTHROSCOPE, 30 DEG, 2.7 X 72MM; ARTHROSCOPE AND ACCESSORIES

Model Number	ARTHROSCOPE, 30 DEG, 2.7 X 72MM
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/19/2023
Type of Reportable Event	Malfunction
Event or Problem Description
On 06/19/2023, it was reported by an arthrex employee via sems that an ar-3350-2730 scope distal lens is damaged.This was discovered during an unspecified time with no patient effect.
Additional Manufacturer Narrative
The contribution of the device to the reported event has not yet been determined as the device has not been returned for evaluation at this time.A follow-up report will be submitted, including a most likely cause if a root cause can not be determined.

• Brand Name: ARTHROSCOPE, 30 DEG, 2.7 X 72MM
• Common Device Name: ARTHROSCOPE AND ACCESSORIES
• 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: emily shafer ; 8009337001
• MDR Report Key: 17343247
• Report Number: 1220246-2023-07190
• Device Sequence Number: 6912713
• Product Code: HRX
• UDI-Device Identifier: 00888867029569
• UDI-Public: 00888867029569
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K080560
• 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
• Report Date (Section B): 07/18/2023

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: ARTHROSCOPE, 30 DEG, 2.7 X 72MM
• Device Catalogue Number: AR-3350-2730
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/19/2023
• Initial Report FDA Received Date: 07/18/2023
• Date Device Manufactured: 11/25/2022
• 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: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown