MAUDE Adverse Event Report: ARTHREX, INC. DRILL JACOBS CHUCK HYBRID 0-7.4MM; POWERED SURG ORTHOPEDIC INSTR

Model Number	DRILL JACOBS CHUCK HYBRID 0-7.4MM
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/01/2021
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.The reported event was confirmed as the manufacturers evaluation revealed both drill chuck and screw at gear rim had come loose.
Event or Problem Description
This is a conversion from (b)(6), line 288584.An customer update was received which made a repair to a complaint.The customer stated the drill chuck is broken during the operation.There was no harm for patient, operator or third party reported.The surgery was finished successfully.It was not necessary to switch the surgical technique or do a second surgery.No further information received.

• Brand Name: DRILL JACOBS CHUCK HYBRID 0-7.4MM
• Common Device Name: POWERED SURG ORTHOPEDIC 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: jared engle ; 8009337001
• MDR Report Key: 19215233
• Report Number: 1220246-2024-02638
• Device Sequence Number: 18203152
• Product Code: HWE
• UDI-Device Identifier: 00888867223486
• UDI-Public: 00888867223486
• Combination Product (Y/N): N
• Initial Reporter Country: GM
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (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): 04/30/2024

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: DRILL JACOBS CHUCK HYBRID 0-7.4MM
• Device Catalogue Number: AR-400DJH74
• Device Lot Number: 10152435
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/04/2021
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/06/2021
• Initial Report FDA Received Date: 04/30/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 09/01/2017
• Is the Device Labeled for Single Use? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown