MAUDE Adverse Event Report: ARTHREX, INC. KIT FOR MICRO S-TAK; BIT, DRILL

Catalog Number	AR-1320DSC
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	08/09/2016
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Patient demographics (age at time of event, date of birth, gender, weight) were requested but not provided.This is the first of two submissions from the same patient event.The other is 1220246-2016-00365 ((b)(4)).No further patient information was provided at the time of this report or made available in response to follow-up communication.No additional adverse consequences have been reported from this event.This device is used for treatment.The contribution of the device to the reported event could not be determined as the device was not returned for evaluation therefore the complainant's event could not be verified.The cause of the event could not be determined from the information available and without device evaluation.Device history record review revealed nothing relevant to this event.This is the first complaint of this type for this part/lot combination.The potential cause(s) of this event will be communicated to the event reporter.If additional relevant information is received, a follow-up report will be submitted.Unknown device disposition.
Event or Problem Description
It was reported that during a hand tfcc reconstruction procedure the disposable kit ar-1320dsc lot 1188386 ((b)(4)) did not have the necessary drill sleeve.The surgeon drilled for the anchors without using a drill sleeve.As a result the anchors ar-1320bcnf, lot 1304766 (qty 2) ((b)(4)) were not secure and pulled out.The procedure was not completed as planned.Instead the procedure was completed by changing the technique and using bone tunnels.

• Brand Name: KIT FOR MICRO S-TAK
• Common Device Name: BIT, DRILL
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• MDR Report Key: 5918035
• Report Number: 1220246-2016-00366
• Device Sequence Number: 19068958
• Product Code: HTW
• UDI-Device Identifier: 00888867009851
• UDI-Public: 00888867009851
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,distri
• Initial Reporter Occupation: Medical Equipment Company Technician/Representative
• Type of Report: Initial
• Report Date (Section B): 08/11/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Expiration Date: 05/01/2019
• Device Catalogue Number: AR-1320DSC
• Device Lot Number: 1188386
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 08/31/2016
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other