MAUDE Adverse Event Report: SMITH & NEPHEW, INC. CLEARTRAC SCOPE/SHAVER CANNULA SMOOTH; ACCESSORIES,ARTHROSCOPIC

Model Number	72201634
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	04/24/2018
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that pieces around the seal (white part) flaked off.A backup device was available to complete the procedure with no delay or patient injuries.
Additional Manufacturer Narrative
Additional information received by the manufacturer has identified that this event should be re-evaluated for mdr reporting.The reassessment determined that the issue does not meet the threshold for reporting and is a non-reportable event.This report was made based upon information which smith & nephew had not been able to investigate or verify prior to the required reporting date.

• Brand Name: CLEARTRAC SCOPE/SHAVER CANNULA SMOOTH
• Common Device Name: ACCESSORIES,ARTHROSCOPIC
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 130 forbes boulevard; mansfield MA 02048
• MDR Report Key: 7510373
• Report Number: 1219602-2018-00587
• Device Sequence Number: 16647075
• Product Code: NBH
• UDI-Device Identifier: 03596010608949
• UDI-Public: (01)03596010608949(17)200518(10)50665053
• Combination Product (Y/N): N
• Initial Reporter State: IL
• 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,user f
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 05/21/2018

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: 72201634
• Device Catalogue Number: 72201634
• Device Lot Number: 50665053
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/03/2018
• Initial Date Received by Manufacturer: 04/24/2018
• Supplement Date Received by Manufacturer: 05/18/2018
• Initial Report FDA Received Date: 05/14/2018
• Supplement Report FDA Received Date: 05/21/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1