MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; ANCHOR, PEEK, PUSH, 2.9 X 10MM

Catalog Number	MRPP2910
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/28/2025
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "when he attempted to mallet the anchor into the hole the anchor broke".
Additional Manufacturer Narrative
The customer reported that the "anchor broke" and stated, "surgeon drilled 2.6 hole for 2.9 anchor.When he attempted to mallet the anchor into the hole the anchor broke".Upon visual inspection of the anchor, the plastic bit at the tip of the anchor was broken, and investigation included review of recent complaint trends/scar activity for the last three trend reports.The complaint was confirmed.No trends were identified for the specified material number and its corresponding defect type, and per dhr reviewed, there seem to be no abnormalities per this item sku and lot.There were no reports of death, serious injury, medical intervention, or follow up care.It has been determined that the reported event could cause or contribute to serious injury if it were to occur again.In an abundance of caution, this is a reportable event.If additional information becomes available this report will be reopened and reevaluated.This medical device report (mdr) is being submitted as part of retrospective review activities, which include review of historical data in accordance with regulations at 21 cfr part 803.The information included in this mdr reflects the information reasonably known to the manufacturer at the time of this retrospective review and submission.

• Brand Name: MEDLINE
• Common Device Name: ANCHOR, PEEK, PUSH, 2.9 X 10MM
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: kim evangelista ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50855427
• Report Number: 1417592-2026-47710
• Device Sequence Number: 9553965
• Product Code: MBI
• UDI-Device Identifier: 10193489104516
• UDI-Public: 10193489104516
• Combination Product (Y/N): N
• Initial Reporter State: MS
• Initial Reporter Country: US
• PMA/510(K) Number: K193108
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Type of Report: Initial
• Report Date (Section B): 09/21/2026

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
• Device Catalogue Number: MRPP2910
• Device Lot Number: 11188
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 07/22/2025
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/28/2025
• Initial Report FDA Received Date: 09/22/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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
• Patient Sequence Number: 1
• Patient Age: 42 YR
• Patient Sex: Female