MAUDE Adverse Event Report: ARTHROCARE CORP. AMBIENT HIPVAC 50 IFS; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES

Catalog Number	ASHA4730-01
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	03/11/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Foreign zip code: (b)(6).
Event or Problem Description
It was reported that during surgery, a piece of plastic from the tip of the device fell off.It was found before the wound could be closed.The piece was found and removed and the wound was closed.The procedure was successfully completed without considerable delay using the same device.No patient injury or other complications were reported.
Additional Manufacturer Narrative
The returned device, intended for use in treatment, was returned for evaluation.There was a relationship between the returned device and the reported event.Visual inspection under magnification shows minimal screen/electrodes wear with scratch/scuff marks and discoloration on the spacer and cap.The insulation on the shaft is damaged and compromised.The detached part was not returned for investigation.There are no manufacturing abnormalities visually observed with the returned device.The device cannot be functional testes due to the damages.The cable and the suction line was cut.The complaint was verified, however the root cause could not be determined with certainty since the device was comprehensively used.Excessive wear of the distal end including the insulation on the shaft results from vigorous use against bony surfaces; the wand is supplied sterile, and is for single use only.Do not clean, resterilize, or reuse the wand, as this may damage or compromise the performance resulting in product malfunction, failure, or patient injury.Cleaning, resterilization, or reuse of the wand may also expose the patient to the risk of transmitting infectious diseases or results in irregular wear leading to malfunction.There were no indications that would suggest that the device did not meet product specifications upon release into distribution.

• Brand Name: AMBIENT HIPVAC 50 IFS
• Common Device Name: ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES
• Manufacturer (Section D): ARTHROCARE CORP.; 7000 w. william cannon; austin TX 78735
• MDR Report Key: 8438261
• Report Number: 3006524618-2019-00150
• Device Sequence Number: 2977775
• Product Code: GEI
• UDI-Device Identifier: 00817470000436
• UDI-Public: 00817470000436
• Combination Product (Y/N): N
• Initial Reporter Country: NO
• PMA/510(K) Number: K083306
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 05/08/2019

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: 09/18/2021
• Device Catalogue Number: ASHA4730-01
• Device Lot Number: 2020967
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/20/2019
• Initial Date Received by Manufacturer: 03/13/2019
• Supplement Date Received by Manufacturer: 05/08/2019; 05/08/2019
• Initial Report FDA Received Date: 03/20/2019
• Supplement Report FDA Received Date: 05/08/2019; 05/08/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 34 YR