MAUDE Adverse Event Report: DEPUY MITEK LLC US MICRO QA+ #4/0 ETH C-1 W/BIT; SOFT-TISSUE ANCHOR, NON-BIOABSORBABLE

Catalog Number	212866
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	04/15/2013
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Udi: (b)(4).The batch review 3623411 showed that the devices were conformed to in process and finished goods specifications when released to stock the 19 june 2012.Expiration date: 2017-06 (according to retained labels).No non-conformance was opened.Evaluation statement: this complaint is being closed since after multiple attempts to retrieve the product, the device has not been returned for evaluation.A batch record review has been conducted to determine if there were any internal processing issues which would have contributed to the nature of the product complaint.Our results indicate that this batch of product was processed without incident and therefore there is no internally assignable cause for the reported problem.Further, a review into the depuy mitek complaints system revealed no other complaints of any kind for this lot of devices that were released to distribution.We cannot discern a root cause for the reported failure mode.At this point in time, no corrective action is required and no further action is warranted.However, depuy mitek will continue to track any related complaints within this device family as a means of monitoring the extent with which this complaint is observed in the field.If and when the device in question is received, this file will be reopened and its contents made to reflect the results of the evaluation.This report is being filed from the remetrex complaint management system as required under mitek's corrective and preventative actions (capa) to file usa fda mdr missed malfunctions.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.
Event or Problem Description
It was reported that the needles broke off the anchor, they then attached a spring loaded needle to attach to the tissue.

• Brand Name: MICRO QA+ #4/0 ETH C-1 W/BIT
• Common Device Name: SOFT-TISSUE ANCHOR, NON-BIOABSORBABLE
• Manufacturer (Section D): DEPUY MITEK LLC US; 325 paramount drive; raynham MA 02767
• MDR Report Key: 7630663
• Report Number: 1221934-2018-50823
• Device Sequence Number: 14081474
• Product Code: HWC
• UDI-Device Identifier: 10886705002535
• UDI-Public: 10886705002535
• Combination Product (Y/N): N
• Initial Reporter Country: AS
• PMA/510(K) Number: K024115
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Health Professional
• Type of Report: Initial
• Report Date (Section B): 04/16/2013

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 Expiration Date: 06/01/2017
• Device Catalogue Number: 212866
• Device Lot Number: 3623411
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 04/16/2013
• Initial Report FDA Received Date: 06/22/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1