MAUDE Adverse Event Report: ARTHREX, INC. PLATE CUTTER; ORTHOPEDIC MANUAL SURG INSTR

Model Number	PLATE CUTTER
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	01/26/2021
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.Complaint confirmed.One unpackaged ar-18700-28, batch 671935 plate cutter was received for investigation.Visual inspection identified that the jaw component at the distal end of the plate cutter was loose due to missing screws, with one piece received separate from the main assembly.The screws were not returned for analysis.The observed condition is most likely the result of wear and tear damage accumulated over repeated usage, as further evidenced by the presence of heavy oxidation across the laser markings.The most likely cause for the reported failure can be attributed to wear and tear.
Event or Problem Description
It was reported that the screws on the ar-18700-28 have come loose over time and are no longer in the instrument.

• Brand Name: PLATE CUTTER
• 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: 19531333
• Report Number: 1220246-2024-05705
• Device Sequence Number: 18036195
• Product Code: LXH
• UDI-Device Identifier: 00888867317833
• UDI-Public: 00888867317833
• Combination Product (Y/N): N
• Initial Reporter State: OH
• 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: Administrator/Supervisor
• Type of Report: Initial
• Report Date (Section B): 06/13/2024

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: PLATE CUTTER
• Device Catalogue Number: AR-18700-28
• Device Lot Number: 671935
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/04/2021
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/26/2021
• Initial Report FDA Received Date: 06/13/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/21/2019
• 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: Unknown
• Patient Sequence Number: 1
• Patient Sex: Unknown