MAUDE Adverse Event Report: DEPUY MITEK LLC US HEALIX TRANSTEND TI ANC W/OC; SOFT-TISSUE ANCHOR, BIOABSORBABLE

Catalog Number	222260
Medical Device Problem Code	Activation, Positioning or Separation Problem (2906)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	05/23/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.(b)(4).The expiration date is not currently available.(b)(6).
Event or Problem Description
It was reported by the distributor that during a shoulder arthroscopy surgery (bankart repair), the anchor kept attached to its insertor.It was impossible to deliver it after the screwing.1 part involved.Additional information received on (b)(6) 2018: no patient impact and there was no delay in procedure.
Additional Manufacturer Narrative
Product complaint # (b)(4).Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.Device was used for treatment, not diagnosis.H10 additional narrative: if information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.Evaluation statement: the complaint device was received and inspected.The complaint can be confirmed.A visual inspection revealed that the anchor was free of any gross visual defects.It was observed that the suture was stuck within the handle.It is possible that the suture is slightly tangled and has caused the anchor to become stuck to the inserter.However, given the information provided we cannot discern a definitive root cause for the reported failure.A non-conformance search was conducted to investigate any defects during production identified that may contribute to the complaint condition.No non-conformance was identified for this part-lot number combination.At this point, no corrective action is required and no further action is warranted.However, depuy synthes 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.Udi: (b)(4) - incomplete.The expiration date is not currently available.

• Brand Name: HEALIX TRANSTEND TI ANC W/OC
• Common Device Name: SOFT-TISSUE ANCHOR, BIOABSORBABLE
• Manufacturer (Section D): DEPUY MITEK LLC US; 325 paramount drive; raynham MA 02767
• MDR Report Key: 7642115
• Report Number: 1221934-2018-52517
• Device Sequence Number: 2482425
• Product Code: HWC
• UDI-Device Identifier: 10886705008063
• UDI-Public: 10886705008063
• Combination Product (Y/N): N
• Initial Reporter Country: FR
• PMA/510(K) Number: K102298
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: foreign,health professional,u
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 05/29/2018

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 Catalogue Number: 222260
• Device Lot Number: L689918
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/14/2018
• Initial Date Received by Manufacturer: 05/29/2018
• Supplement Date Received by Manufacturer: 11/05/2018
• Initial Report FDA Received Date: 06/27/2018
• Supplement Report FDA Received Date: 11/06/2018
• Patient Sequence Number: 1
• Patient Age: 38 YR