BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ARTHRO TISSLIB BLADE UP *EA

    MDR report key: 8288663 · Received January 30, 2019

    Report

    Report Number
    1221934-2019-56254
    Event Type
    Malfunction
    Date Received
    January 30, 2019
    Date of Event
    August 31, 2016
    Report Date
    September 1, 2016
    Manufacturer
    DEPUY MITEK LLC US
    Product Code
    NBH
    UDI-DI
    10886705004065
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    IF ADDITIONAL INFORMATION SHOULD BECOME AVAILABLE, A SUPPLEMENTAL MEDWATCH WILL BE SUBMITTED ACCORDINGLY. (B)(4). THE COMPLAINT DEVICE IS NOT BEING RETURNED, THEREFORE UNAVAILABLE FOR A PHYSICAL EVALUATION. A REVIEW INTO THE DEPUY SYNTHES MITEK COMPLAINTS SYSTEM REVEALED NO OTHER COMPLAINTS 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. THIS FILE WILL REMAIN RECEPTIVE TO ANY POTENTIAL FORTHCOMING INFORMATION RECEIVED THAT IS PERTINENT AND GERMANE TO THIS ISSUE. A DEVICE HISTORY 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; THEREFORE, THERE IS NO EVIDENCE OF MANUFACTURING ANOMALIES ON THE PAPERWORK REVIEWED . DHR REVIEW: PART NUMBER: 214623; SUPPLIER LOT NUMBER: 08H3; QTY OF LOT: 27; RELEASE TO WAREHOUSE DATE: 24 DEVICES SUPPLIED ON THE 31ST OF AUGUST 2008 AND 3 SUPPLIED ON 12TH OF OCTOBER 2008; MANUFACTURING DATE: AUGUST 2008; EXPIRATION DATE: NA; SUPPLIER: TAG; MANUFACTURING SITE: TAG; ANY ANOMALIES OR DISCREPANCIES IN THE MANUFACTURE OF THE LOT: NONE. HOWEVER, DEPUY SYNTHES 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. THIS REPORT IS BEING FILED FROM THE (B)(4) AS REQUIRED UNDER MITEK'S CORRECTIVE AND PREVENTATIVE ACTIONS (CAPA) TO FILE USA FDA MDR MISSED MALFUNCTIONS. (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING A SHOULDER SCOPE SURGICAL PROCEDURE, IT WAS OBSERVED THAT THE HANDLE ON THE TISSUE LIBERATOR SEPARATED FROM THE SHAFT. THE DEVICE BROKE STAYED OUTSIDE THE PATIENT AND CONFIRMED THAT NO DEBRIS FELL IN THE PATIENT. THE SURGEON COMPLETED THE PROCEDURE WITH ANOTHER LIKE DEVICE WITH NO PATIENT CONSEQUENCES OR DELAYS. THERE WAS PATIENT INVOLVEMENT REPORTED. THERE WERE NO INJURIES, MEDICAL INTERVENTION OR PROLONGED HOSPITALIZATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    83197 ARTHRO TISSLIB BLADE UP *EA ORTHOPAEDIC KNIFE NBH DEPUY MITEK LLC US 08H3 10886705004065

    Patients

    Seq Age Sex Outcome Treatment
    1