MAUDE Adverse Event Report: ARTHREX, INC. SUPERMX NITI STAPLE W/ INSTRS, 20W X 20L; STAPLE, FIXATION, BONE

Model Number	SUPERMX NITI STAPLE W/ INSTRS, 20W X 20L
Medical Device Problem Code	Patient Device Interaction Problem (4001)
Health Effect - Clinical Code	Pain (1994)
Date of Event	04/01/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The contribution of the device to the reported event could not be determined as the device was not returned for evaluation.The root cause of the event could not be determined from the information available and without device evaluation.If the device becomes available for evaluation, a follow-up report will be submitted.
Event or Problem Description
On (b)(6) 2024 it was reported by a facility representative via email that a post-market clinical study was performed for a clinical outcome of midfoot arthrodesis using the arthrex dynanite staple.The patient had two ar-8719mxds-2020 dynanite supermx nitinol staple implanted.On (b)(6) 2022, post-operation, the patient presented with pain.The patient underwent revision surgery on (b)(6) 2022 for hardware removal.No further information has been reported.Additional information requested.
Additional Manufacturer Narrative
Additional information: b5, d9, h6.Additional information received on 5/22/2024: the patient underwent original surgery on (b)(6) 2020, due to irritation and pain from prominence over the medial forefoot, the patient underwent revision surgery.At this time, it is unknown which products were explanted, per the facility representative, it was not documented in the operative report notes.The same surgeon performed both surgeries.
Event or Problem Description
Additional information received on 5/22/2024: the patient underwent original surgery on (b)(6) 2020.Due to irritation and pain from prominence over the medial forefoot, the patient underwent revision surgery.At this time, it is unknown which products were explanted, per the facility representative, it was not documented in the operative report notes.The same surgeon performed both surgeries.
Additional Manufacturer Narrative
Additional information: g3, h3, h6.Based on the information provided which may include the device (if available and returned), pictures, videos, event description, and any additional information from the field, arthrex was able to conclude a most likely cause.The most likely cause for the reported failure can be attributed to a patient-specific event.

• Brand Name: SUPERMX NITI STAPLE W/ INSTRS, 20W X 20L
• Common Device Name: STAPLE, FIXATION, BONE
• 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: 19446485
• Report Number: 1220246-2024-04679
• Device Sequence Number: 14268845
• Product Code: JDR
• UDI-Device Identifier: 00888867300903
• UDI-Public: 00888867300903
• Combination Product (Y/N): N
• Initial Reporter State: TN
• Initial Reporter Country: US
• PMA/510(K) Number: K203180
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Explanted Year: 2022
• Reporter Type: Manufacturer
• Report Source: Study,User Facility
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 06/30/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Expiration Date: 07/31/2025
• Device Model Number: SUPERMX NITI STAPLE W/ INSTRS, 20W X 20L
• Device Catalogue Number: AR-8719MXDS-2020
• Device Lot Number: 0217105528
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/06/2024
• Supplement Date Received by Manufacturer: Not provided; 06/06/2025
• Initial Report FDA Received Date: 06/03/2024
• Supplement Report FDA Received Date: 06/20/2024; 06/30/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 08/01/2020
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown