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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE SERFAS ENERGY 90-S CRUISE; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES

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STRYKER ENDOSCOPY-SAN JOSE SERFAS ENERGY 90-S CRUISE; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES Back to Search Results
Catalog Number 0279401200
Device Problem Continuous Firing (1123)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 03/21/2023
Event Type  malfunction  
Event Description
It was reported that the device continuously activated.
 
Manufacturer Narrative
Additional information will be provided once the investigation has been completed.The device manufacturer date is not known at this time.However, should it become available it will be provided in future reports.
 
Manufacturer Narrative
Alleged failure: the electrode wouldn't stop the failure(s) identified in the investigation is consistent with the complaint record.The probable root cause/s could be the polyimide's pin became exposed and indirect contact (sparks) with the hood during use, creating a short circuit (hole in the hood) between the active pin and the hood disabling the unit to continue operation.Lack of glue around the polyimide, the glue could have been scratched during the placement of the hood and damaged during pin bending.The product was returned for investigation and the failure mode will be monitored for future reoccurrence.The device manufacturer date is not known.
 
Event Description
It was reported that the device continuously activated.
 
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Brand Name
SERFAS ENERGY 90-S CRUISE
Type of Device
ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES
Manufacturer (Section D)
STRYKER ENDOSCOPY-SAN JOSE
5900 optical court
san jose CA 95138
Manufacturer (Section G)
STRYKER ENDOSCOPY-SAN JOSE
5900 optical court
san jose CA 95138
Manufacturer Contact
lucas wolski
5900 optical court
san jose, CA 95138
4087542000
MDR Report Key17608121
MDR Text Key321805720
Report Number0002936485-2023-00857
Device Sequence Number1
Product Code GEI
UDI-Device Identifier07613327057034
UDI-Public07613327057034
Combination Product (y/n)N
Reporter Country CodeFR
PMA/PMN Number
K160050
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Health Professional
Reporter Occupation Pharmacist
Type of Report Initial,Followup
Report Date 03/08/2024
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
Device Operator Other
Device Catalogue Number0279401200
Device Lot NumberUNKNOWN
Was Device Available for Evaluation? Device Returned to Manufacturer
Is the Reporter a Health Professional? Yes
Initial Date Manufacturer Received Not provided
Initial Date FDA Received08/23/2023
Supplement Dates Manufacturer Received03/21/2023
Supplement Dates FDA Received03/08/2024
Was Device Evaluated by Manufacturer? Yes
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
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