MAUDE Adverse Event Report: DEPUY MITEK LLC US 2.0MM TACIT QUICKANCHOR #2/0 W/V-5 TAPERCUT NEEDLES W/INSERTER & CRANIO DRILL; SOFT-TISSUE ANCHOR, NON-BIOABSORBABLE

Catalog Number	212236
Medical Device Problem Code	Migration or Expulsion of Device (1395)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	11/06/2013
Type of Reportable Event	Malfunction
Additional Manufacturer 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 is not being returned, therefore is unavailable for a physical 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.(b)(4).
Event or Problem Description
It was reported by the sales rep that during a brow lift that the customer's tacit quick anchor pulled out after it was initially inserted.The sales rep reported the surgeon prepped the bone hole, and had just inserted the anchor when it came right out.The anchor was off the inserter at the time.The surgeon completed the procedure with another like device with no patient consequences and a 5 minute delay.The customer already discarded the anchor.No further information was available.

• Brand Name: 2.0MM TACIT QUICKANCHOR #2/0 W/V-5 TAPERCUT NEEDLES W/INSERTER & CRANIO DRILL
• Common Device Name: SOFT-TISSUE ANCHOR, NON-BIOABSORBABLE
• Manufacturer (Section D): DEPUY MITEK LLC US; 325 paramount drive; raynham MA 02767
• MDR Report Key: 7677532
• Report Number: 1221934-2018-52250
• Device Sequence Number: 1554226
• Product Code: MBI
• UDI-Device Identifier: 10886705002023
• UDI-Public: 10886705002023
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K961094
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 11/06/2013

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: 10/31/2018
• Device Catalogue Number: 212236
• Device Lot Number: 3728473
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 11/06/2013
• Initial Report FDA Received Date: 07/11/2018
• Patient Sequence Number: 1