MAUDE Adverse Event Report: ARTHREX, INC. MINIMALLY INVASIVE GRAFT HARVESTER, OPEN; ORTHOPEDIC MANUAL SURG INSTR

Model Number	MINIMALLY INVASIVE GRAFT HARVESTER, OPEN
Medical Device Problem Code	Dull, Blunt (2407)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/05/2021
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 devices are dull.The reported event was confirmed as the visual evaluation revealed that the cutting edge is caved.Further the laser marks are slightly faded.The most likely cause for the reported failure can be attributed to wear and tear.
Event or Problem Description
It was reported that the devices are dull.No additional information as to what failure mode occurred was provided.There was no harm or adverse event for patient, operator or third party reported by the customer.No further information received.

• Brand Name: MINIMALLY INVASIVE GRAFT HARVESTER, OPEN
• 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: 19393535
• Report Number: 1220246-2024-03881
• Device Sequence Number: 6776357
• Product Code: MDM
• UDI-Device Identifier: 00888867006928
• UDI-Public: 00888867006928
• Combination Product (Y/N): N
• Initial Reporter Country: GM
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (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: MINIMALLY INVASIVE GRAFT HARVESTER, OPEN
• Device Catalogue Number: AR-1278PL
• Device Lot Number: 04512033
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/01/2021
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/05/2021
• Initial Report FDA Received Date: 05/24/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 08/26/2020
• 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