MAUDE Adverse Event Report: ARTHREX, INC. PERC INSERT KIT FOR 3.0MM S-TAK; ORTHOPEDIC MANUAL SURG INSTR

Model Number	PERC INSERT KIT FOR 3.0MM S-TAK
Medical Device Problem Code	Physical Resistance/Sticking (4012)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/10/2023
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
On (b)(6),2023 it was reported by a sales representative via (b)(4) that an ar-1934pi-30 percutaneous insertion kits drill got stuck in the guide and could not be removed.This occurred during a case, and another drill was used to complete the case.There was no patient effect reported.
Additional Manufacturer Narrative
Additional information: g3, h3, h6 the complaint allegation cannot be confirmed as the device was not received for evaluation, and no pictures of the failure were received.Based on the information provided, which may include the device (if available and returned), pictures, videos, event description, and any additional information from the field, arthrex concluded that the most likely related to a user error such as improper bone preparation, misaligned insertion, and/or prying/levering the device during insertion.

• Brand Name: PERC INSERT KIT FOR 3.0MM S-TAK
• Common Device Name: ORTHOPEDIC MANUAL SURG INSTR
• 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: 18074015
• Report Number: 1220246-2023-08570
• Device Sequence Number: 7815679
• Product Code: LXH
• UDI-Device Identifier: 00888867024151
• UDI-Public: 00888867024151
• Combination Product (Y/N): N
• Initial Reporter State: NY
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup
• Report Date (Section B): 01/16/2025

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: PERC INSERT KIT FOR 3.0MM S-TAK
• Device Catalogue Number: AR-1934PI-30
• Device Lot Number: 15045494
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/10/2023
• Supplement Date Received by Manufacturer: 12/20/2024
• Initial Report FDA Received Date: 11/06/2023
• Supplement Report FDA Received Date: 01/16/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/17/2023
• 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
• Patient Sex: Unknown