MAUDE Adverse Event Report: ARTHREX, INC. RETROCUTTER, 9 MM; MANUAL INSTR, GENERAL SURGICAL

Model Number	RETROCUTTER, 9 MM
Medical Device Problem Code	Fitting Problem (2183)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/08/2022
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.Complaint confirmed.One unpackaged ar-1204r-09s retrocutter®, 9.0 mm serial/batch number (b)(6) was received for investigation.No functional testing performed due to the lack of ar-1250rp retrodrill reamer.Visual evaluation found scratches and burrs in the sharp cutting edges as well as inside in the thread area.The most likely cause for the reported failure can be attributed to user error of the device due to misaligned insertion.
Event or Problem Description
It was reported on 11/08/2022 by a sales representative via sems that an ar-1204r-09s retro cutter would not sit inside the guide.Case involvement, no patient effect.

• Brand Name: RETROCUTTER, 9 MM
• Common Device Name: MANUAL INSTR, GENERAL SURGICAL
• 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: 19471573
• Report Number: 1220246-2024-04983
• Device Sequence Number: 7452021
• Product Code: HWE
• UDI-Device Identifier: 00888867004764
• UDI-Public: 00888867004764
• Combination Product (Y/N): N
• Initial Reporter State: WI
• 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 Expiration Date: 05/31/2024
• Device Model Number: RETROCUTTER, 9 MM
• Device Catalogue Number: AR-1204R-09S
• Device Lot Number: 10328335
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/20/2022
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/08/2022
• Initial Report FDA Received Date: 06/05/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 06/27/2019
• Is the Device Labeled for Single Use? (Y/N): Yes
• 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