MAUDE Adverse Event Report: ARTHREX, INC. TROCAR FOR INFLOW CANNULA; ARTHROSCOPIC ACCESSORIES

Model Number	TROCAR FOR INFLOW CANNULA
Medical Device Problem Code	Corroded (1131)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/08/2022
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.Event description: it was reported that there is rust on valve for inflow.It is inside the pipe and also visible when turning the handle.The reported event was partly confirmed as the visual evaluation revealed that the device has no valve or pipe.However the device shows signs of metal surface oxidation on the head (see evaluation picture 3).The most likely cause for the reported failure can be attributed to user error of the device due to improper detergent/cleaning process used.
Event or Problem Description
It was reported that there is rust on valve for inflow.It is inside the pipe and also visible when turning the handle.There was no harm or adverse event for patient, operator or third party reported.No further information received.

• Brand Name: TROCAR FOR INFLOW CANNULA
• Common Device Name: ARTHROSCOPIC ACCESSORIES
• 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: 19570689
• Report Number: 1220246-2024-06221
• Device Sequence Number: 12503424
• Product Code: NBH
• UDI-Device Identifier: 00888867039476
• UDI-Public: 00888867039476
• Combination Product (Y/N): N
• Initial Reporter Country: SW
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Company Representative
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial
• Report Date (Section B): 06/19/2024

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: TROCAR FOR INFLOW CANNULA
• Device Catalogue Number: AR-6502
• Device Lot Number: 011625
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/24/2022
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/08/2022
• Initial Report FDA Received Date: 06/19/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 06/24/2016
• 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: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown