MAUDE Adverse Event Report: DEPUY MITEK LLC US CHIA SUTURE PASSER; SUTURE/NEEDLE PASSER, SINGLE-USE

Catalog Number	214101
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	04/01/2014
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.Investigation summary: 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.Device history lot : a check of the manufacturing finished goods records for the reported batch number revealed no anomalies relating to the reported incident.There were units released for distribution on may 24, 2013 with an expiration date of 2018-04.There were no anomalies or discrepancies in the manufacture of this lot.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
The surgeon was doing an arthroscopic labral repair.He attempted to pass/shuttle suture through the tissue and the top of the chia kite/loop from the ideal passer broke open.He then opened a new chia wire and attempted another pass.It too broke at the top of the kite/loop.He used his old manual instruments and a pds suture loop.Please see also medwatch report 1221934-2018-54120.

• Brand Name: CHIA SUTURE PASSER
• Common Device Name: SUTURE/NEEDLE PASSER, SINGLE-USE
• Manufacturer (Section D): DEPUY MITEK LLC US; 325 paramount drive; raynham MA 02767
• MDR Report Key: 7708707
• Report Number: 1221934-2018-54119
• Device Sequence Number: 1753584
• Product Code: LXH
• UDI-Device Identifier: 10886705003433
• UDI-Public: 10886705003433
• Combination Product (Y/N): N
• Initial Reporter State: IA
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: other
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 04/01/2014

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: 04/30/2018
• Device Catalogue Number: 214101
• Device Lot Number: 1304003
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 04/01/2014
• Initial Report FDA Received Date: 07/21/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1