MAUDE Adverse Event Report: ARTHREX, INC. DYNANITE¿ STAPLE DRL BT, CAL, 1.6, REUSE; DRILL BIT

Model Number	DYNANITE¿ STAPLE DRL BT, CAL, 1.6, REUSE
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/20/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
This 3500a record is submitted to comply with an fda 483 inspectional observation issued to arthrex inc on may 5, 2023.Arthrex has reassessed the reportability decisions made on historical complaint records using revised criterion.This 3500a document is a result of the reassessment.Complaint confirmed.Visual inspection identified that the drill bit shaft has broken off and tip is stuck inside the returned drill guide.A likely cause of the event is prying/leveraging the mating drill bit during use.
Event or Problem Description
It was reported that during a case, when drilling with the ar-8717d-01-ru, the drill locked in the ar-8717g-01 parallel guide.There was no adverse effect to the patient reported.

• Brand Name: DYNANITE¿ STAPLE DRL BT, CAL, 1.6, REUSE
• Common Device Name: DRILL BIT
• 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: jared engle ; 8009337001
• MDR Report Key: 19165145
• Report Number: 1220246-2024-02253
• Device Sequence Number: 7938006
• Product Code: HTW
• UDI-Device Identifier: 00888867326163
• UDI-Public: 00888867326163
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• 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: Foreign,Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 04/23/2024

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 Model Number: DYNANITE¿ STAPLE DRL BT, CAL, 1.6, REUSE
• Device Catalogue Number: AR-8717D-01-RU
• Device Lot Number: 031938
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/20/2021
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/20/2021
• Initial Report FDA Received Date: 04/23/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/01/2019
• 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: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown