MAUDE Adverse Event Report: ARTHREX, INC. SCORPION SUTURE PASSER, 16 MM; ORTHOPEDIC MANUAL SURG INSTR

Model Number	SCORPION SUTURE PASSER, 16 MM
Medical Device Problem Code	Device Damaged by Another Device (2915)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/18/2021
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 is -partly - confirmed as the picture provided by the user shows a frayed suture.Both scorpion instrument and used needle have not been returned and therefore it was not possible to perform any evaluation on them.The most likely cause for the reported failure can be attributed to user error of the device due to excessive force being used during firing of the needle and/or unsecure grasp of tissue.
Event or Problem Description
It was reported that during a shoulder surgery the suture didn´t pass through the tissue.The needle damaged the suture.No harm for patient, operator or third party was reported.The surgery was finished successfully with a express suture passer.It was not necessary to switch the surgical technique or do a second surgery.

• Brand Name: SCORPION SUTURE PASSER, 16 MM
• Common Device Name: ORTHOPEDIC MANUAL SURG 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: 19387658
• Report Number: 1220246-2024-03788
• Device Sequence Number: 4071547
• Product Code: LXH
• UDI-Device Identifier: 00888867015906
• UDI-Public: 00888867015906
• Combination Product (Y/N): N
• Initial Reporter Country: PO
• 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): 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 Model Number: SCORPION SUTURE PASSER, 16 MM
• Device Catalogue Number: AR-13990
• Device Lot Number: 35293
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/18/2021
• Initial Report FDA Received Date: 05/23/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown