MAUDE Adverse Event Report: DEPUY MITEK HEALIX ADVANCE PEEK ANCHOR, 5.5 MM W/ORTHOCORD - 3 SUTURE; SOFT-TISSUE ANCHOR, NON-BIOABSORBABLE

Catalog Number	222307
Medical Device Problem Code	Difficult to Advance (2920)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	01/22/2014
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 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).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.
Event or Problem Description
It was reported by the hospital that the surgeon was doing a rotator cuff repair and had already used two healix advance anchors.It was reported that the first two anchors went in great and had good purchase, but the third one pulled out when he went to pull the inserter out of the anchor.It was reported that the surgeon properly undid the sutures before pulling on the inserter to remove it and when he pulled the anchor came with the inserter.The surgeon had them open a new anchor, and to be safe, punched another hole in a new spot and the anchor held great.It was reported that the surgeon was not entirely convinced that it wasn¿t just a weak spot in the patients bone.It was not reported if there were any delays in the surgical procedure.But regardless did not want to pay for the anchor that pulled out.I was unable to attend this case, dr.(b)(6) and his pa reported this to me the day after the case.There was patient involvement reported.There were no injuries, medical intervention or prolonged hospitalization.All available information has been disclosed.If additional information should become available, a supplemental medwatch report will be submitted accordingly.

• Brand Name: HEALIX ADVANCE PEEK ANCHOR, 5.5 MM W/ORTHOCORD - 3 SUTURE
• Common Device Name: SOFT-TISSUE ANCHOR, NON-BIOABSORBABLE
• Manufacturer (Section D): DEPUY MITEK; 325 paramount drive; raynham MA 02767
• MDR Report Key: 7704151
• Report Number: 1221934-2018-52999
• Device Sequence Number: 600725
• Product Code: HWC
• UDI-Device Identifier: 10886705021420
• UDI-Public: 10886705021420
• Combination Product (Y/N): N
• Initial Reporter State: NE
• PMA/510(K) Number: K120449
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: user facility
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 01/28/2014

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: 09/01/2016
• Device Catalogue Number: 222307
• Device Lot Number: 3731490
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 01/28/2014
• Initial Report FDA Received Date: 07/19/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): Yes
• Patient Sequence Number: 1