MAUDE Adverse Event Report: SMITH & NEPHEW, INC. GUIDE FISH MOUTH TIP 2.9MM INLINE; ACCESSORIES,ARTHROSCOPIC

Model Number	72201389
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	05/23/2018
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that sales representative noticed that there is a friction point and drill bit will not slide through drill guide.No back up device was available.No patient injury was reported.
Additional Manufacturer Narrative
Examination was not possible, as the device has not been returned.The investigation could not draw any conclusions about the reported event without the return of the device.
Additional Manufacturer Narrative
Additional information received by the manufacturer has identified that this event should be re-evaluated for mdr reporting: the event was reported because there was no back up device available during the procedure, however per communication with the sales representative, it was confirmed that there was a smith and nephew back up device available to complete the procedure succesfully therefore the reassessment determined that the issue does not meet the threshold for reporting and is a non-reportable event.This report was made based upon information which smith & nephew had not been able to investigate or verify prior to the required reporting date.

• Brand Name: GUIDE FISH MOUTH TIP 2.9MM INLINE
• Common Device Name: ACCESSORIES,ARTHROSCOPIC
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 130 forbes boulevard; mansfield MA 02048
• MDR Report Key: 7727939
• Report Number: 1219602-2018-00953
• Device Sequence Number: 1405619
• Product Code: NBH
• UDI-Device Identifier: 03596010595522
• UDI-Public: (01)03596010595522(10)50572382
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,user f
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 08/09/2018

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 Model Number: 72201389
• Device Catalogue Number: 72201389
• Device Lot Number: 50572382
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 07/02/2018
• Supplement Date Received by Manufacturer: 08/07/2018; 08/27/2018
• Initial Report FDA Received Date: 07/27/2018
• Supplement Report FDA Received Date: 08/09/2018; 08/29/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1