MAUDE Adverse Event Report: ARTHROCARE CORPORATION 7.5CM ANTERIOR/POSTERIOR; BALLOON, EPISTAXIS

Catalog Number	RR 750
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that after an ent procedure, the rapid rhino swollow guard part detached and fell off.No further complications were reported.
Additional Manufacturer Narrative
H10: internal complaint reference:(b)(4).
Event or Problem Description
It was reported that after an ent procedure, the rapid rhino swollow guard part detached and fell off.The device had to be extracted with forceps.No further complications were reported.
Additional Manufacturer Narrative
H3, h6: a device deficiency was not identified, and the root cause of the reported event could not be determined since the device was not returned for evaluation.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.Please refer to the instructions for use for precautions and warnings related to the use of the device.No containment or corrective actions are recommended at this time.B5 was corrected.
Event or Problem Description
It was reported that after an ent procedure, the rapid rhino swallow guard part detached and fell off.The device had to be extracted from patient using forceps.No further complications were reported.

• Brand Name: 7.5CM ANTERIOR/POSTERIOR
• Common Device Name: BALLOON, EPISTAXIS
• Manufacturer (Section D): ARTHROCARE CORPORATION; 7000 west william cannon drive; austin TX 78735
• Manufacturer (Section G): ARTHROCARE CORPORATION; 7000 west william cannon drive; austin TX 78735
• Manufacturer Contact: holly topping ; 7000 west william cannon drive; austin, TX 78735 ; 5123913905
• MDR Report Key: 19130512
• Report Number: 3006524618-2024-00150
• Device Sequence Number: 17300966
• Product Code: EMX
• UDI-Device Identifier: 00817470006636
• UDI-Public: 00817470006636
• Combination Product (Y/N): N
• Initial Reporter Country: UK
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 05/23/2024

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 Expiration Date: 09/08/2026
• Device Catalogue Number: RR 750
• Device Lot Number: 2124692
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/01/2024
• Supplement Date Received by Manufacturer: 01/31/2024; 05/21/2024
• Initial Report FDA Received Date: 04/18/2024
• Supplement Report FDA Received Date: 05/06/2024; 05/23/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 09/08/2023
• 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