MAUDE Adverse Event Report: ARTHREX, INC. NANOSCOPE CONSOLE; LAPAROSCOPE

Model Number	NANOSCOPE CONSOLE
Medical Device Problem Code	Unexpected Shutdown (4019)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/13/2021
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: the device started to work and suddenly became out of order during the tests.The reported event was confirmed as the service evaluation revealed the device has no function at all.The console will be returned to the vendor for further service.
Event or Problem Description
It was reported that the device is out of order/ burned while tested.There was no harm or adverse event for patient, operator or third party reported.No further information received.Update, 15-sep-2021 sac.Received further information that the device started to work and suddenly became out of order during the tests.The device started but nothing appeared on the monitor right after.

• Brand Name: NANOSCOPE CONSOLE
• Common Device Name: LAPAROSCOPE
• 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: 19352736
• Report Number: 1220246-2024-03532
• Device Sequence Number: 7232785
• Product Code: GCJ
• UDI-Device Identifier: 00888867299580
• UDI-Public: 00888867299580
• Combination Product (Y/N): N
• Initial Reporter Country: FR
• PMA/510(K) Number: K201134
• 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): 05/20/2024

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: NANOSCOPE CONSOLE
• Device Catalogue Number: AR-3200-0030
• Device Lot Number: 202009
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/23/2021
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/13/2021
• Initial Report FDA Received Date: 05/20/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 03/17/2020
• 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