MAUDE Adverse Event Report: ARTHREX, INC. RADIOLUCENT RETRACTOR, 38 DEG BLUNT TIP; ARTHROSCOPIC ACCESSORIES

Model Number	RADIOLUCENT RETRACTOR, 38 DEG BLUNT TIP
Medical Device Problem Code	Device Damaged by Another Device (2915)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/02/2021
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.Event description: it was reported that the lever surface of the device was destroyed by the customer with a saw.The surface of the device has indentations and scratches and can therefore no longer be used.The reported event was confirmed as the visual evaluation revealed that deep gouge marks in the radiolucent (aluminum) portion of the device.
Event or Problem Description
It was reported that the lever surface of the device was destroyed by the customer with a saw.The surface of the device has indentations and scratches and can therefore no longer be used.There was no harm or adverse event for patient, operator or third party reported.No further information received.

• Brand Name: RADIOLUCENT RETRACTOR, 38 DEG BLUNT TIP
• Common Device Name: ARTHROSCOPIC 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: jared engle ; 8009337001
• MDR Report Key: 19255780
• Report Number: 1220246-2024-02856
• Device Sequence Number: 6590181
• Product Code: NBH
• UDI-Device Identifier: 00888867011359
• UDI-Public: 00888867011359
• 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: Administrator/Supervisor
• Type of Report: Initial
• Report Date (Section B): 05/06/2024

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: RADIOLUCENT RETRACTOR, 38 DEG BLUNT TIP
• Device Catalogue Number: AR-13325
• Device Lot Number: 85712040
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/13/2021
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/02/2021
• Initial Report FDA Received Date: 05/06/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 01/13/2021
• 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