MAUDE Adverse Event Report: ARTHREX, INC. HD ARTHROSCOPE, 30 DEG, 3 X 138MM; ARTHROSCOPE AND ACCESSORIES

Model Number	HD ARTHROSCOPE, 30 DEG, 3 X 138MM
Medical Device Problem Code	Damaged Thread (4075)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/12/2023
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the thread on the arthroscope is defective.There was no harm for patient, operator or third party.No further information received.
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 evaluation revealed that there are damages on the light post (see evaluation pictures 3 + 4).The complainant's event is typically caused by metal-to-metal contact with another instrument/tool.Further, the shaft is slightly bend and therefore the rod lens is broken, and the distal tip is damaged (see evaluation pictures 5 + 6).The most likely cause for the reported failure can be attributed to misuse/mishandling due to damage to the device.

• Brand Name: HD ARTHROSCOPE, 30 DEG, 3 X 138MM
• Common Device Name: ARTHROSCOPE AND 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: 19390315
• Report Number: 1220246-2024-03815
• Device Sequence Number: 12684996
• Product Code: HRX
• UDI-Device Identifier: 00888867029590
• UDI-Public: 00888867029590
• Combination Product (Y/N): N
• Initial Reporter Country: SZ
• PMA/510(K) Number: K080560
• 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): 05/24/2024

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: HD ARTHROSCOPE, 30 DEG, 3 X 138MM
• Device Catalogue Number: AR-3350-3030
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/23/2023
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/12/2023
• Initial Report FDA Received Date: 05/24/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 04/29/2015
• 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