| Brand Name | DISP FLUSHFIT CNULA KIT, XL |
| Common Device Name | MANUAL INSTR, GENERAL SURGICAL |
| Manufacturer (Section D) |
| Arthrex, Inc. |
| 1370 creekside boulevard |
| naples FL 34108 -194 |
|
| Manufacturer (Section G) |
| Arthrex, Inc. |
| 1370 creekside boulevard |
|
| naples FL 34108 -194 |
|
| Manufacturer Contact |
|
jared
engle
|
|
+1(800)933-7001
|
|
| MDR Report Key | 50733718 |
| Report Number | 1220246-2026-04690 |
| Device Sequence Number | 10575257 |
| Product Code |
NBH
|
| UDI-Device Identifier | 00888867382350 |
| UDI-Public | (01)00888867382350(11)260401(17)310331(10)6069177659 |
| Combination Product (Y/N) | N |
| Initial Reporter State | ID |
| 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) |
09/11/2026 |
| 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 | DISP FLUSHFIT CNULA KIT, XL |
| Device Catalogue Number | AR-3390HL |
| Device Lot Number | 6069177659 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/24/2026 |
| Initial Report FDA Received Date | 09/11/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 04/01/2026 |
| 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 |