MAUDE Adverse Event Report: ARTHREX, INC. REELPASS SUTR LASSO,45° CRV LFT; ORTHOPEDIC MANUAL SURG INSTR

Model Number	REELPASS SUTR LASSO,45° CRV LFT
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/27/2022
Type of Reportable Event	Malfunction
Event or Problem Description
On 5/27/2022 it was reported by a sales representative via sems that an ar-6069-45l and an ar-6069-45r suture lasso had an issue during a right shoulder repair procedure.As they began to repair the labrum, anterior then posterior, they opened up two reelpass suture passers, one left and one right.They used the right one first, which seemed to work out of the package, but once it was inside the joint it would only feed a couple on inches of monofilament into the joint.The passer was removed from the shoulder and monofilament pulled out of the passer in order to clear any blockages.It was then reintroduced into the shoulder but the issue persisted.A second 45r reelpass was opened but the same issue happened with this one as well.To successfully complete the anterior repair a non-arthrex product was opened.Turning to the posterior side we began using the 45l reelpass, but this too experienced the same issue as the 45rs.Once it was determined that the passer would not expel monofilament, a non-arthrex product was opened in order to complete the repair.The procedure was completed with no patient affect.
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 complaint device was not received for evaluation.Based off the information provided, the most likely cause for the reported failure can be attributed to misuse/mishandling due to damage to the device.However, due to the device being returned unpackaged, we are unable to confirm the reported event.

• Brand Name: REELPASS SUTR LASSO,45° CRV LFT
• 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: 19469351
• Report Number: 1220246-2024-04947
• Device Sequence Number: 11626906
• Product Code: LXH
• UDI-Device Identifier: 00888867115866
• UDI-Public: 00888867115866
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 06/05/2024

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: REELPASS SUTR LASSO,45° CRV LFT
• Device Catalogue Number: AR-6069-45L
• Device Lot Number: 14917318
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/27/2022
• Initial Report FDA Received Date: 06/05/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/21/2022
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown