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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE COBRA SUTURE PASSER, CAPTURE; ACCESSORIES, ARTHROSCOPIC

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STRYKER ENDOSCOPY-SAN JOSE COBRA SUTURE PASSER, CAPTURE; ACCESSORIES, ARTHROSCOPIC Back to Search Results
Model Number 3910900093
Device Problems Break (1069); Material Integrity Problem (2978)
Patient Problems Foreign Body In Patient (2687); No Clinical Signs, Symptoms or Conditions (4582)
Event Date 11/28/2022
Event Type  Injury  
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.
 
Event Description
It was reported that the needle broke during the procedure and potentially remained in the patient.
 
Manufacturer Narrative
This complaint investigation was closed based on the device not received, therefore the reported failure mode was not confirmed.In the event that the device is received, the complaint will be reopened and the investigation will be updated with new results.Alleged failure: bent/broken.Probable root cause: design: inadequate raw material selection, tip geometry not designed to facilitate soft tissue penetration, needle not designed to withstand multiple usages/reprocessing cycles.Process: instrument not manufactured / serviced to specification.Application: attempt to use the device with broken or bent needle, attempt to pass through thick tissue or bone, excessive tissue loaded into jaws (g10), lack of due care when inserting instrument into soft tissue (g4), use of excessive force (g5), attempt to load or pass incompatible suture (g6), technique error (g7), improper reprocessing cycles/agents used; reprocessing instructions not followed.(r1) the reported failure mode will be monitored for future reoccurrence.Manufacture date is not known.
 
Event Description
It was reported that the needle broke during the procedure and potentially remained in the patient.
 
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Brand Name
COBRA SUTURE PASSER, CAPTURE
Type of Device
ACCESSORIES, ARTHROSCOPIC
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 Key16064906
MDR Text Key306323095
Report Number0002936485-2022-00807
Device Sequence Number1
Product Code NBH
UDI-Device Identifier07613327413595
UDI-Public07613327413595
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
EXEMPT
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Consumer
Reporter Occupation Other
Type of Report Initial,Followup
Report Date 02/16/2023
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received12/28/2022
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Model Number3910900093
Device Catalogue Number3910-900-093
Was Device Available for Evaluation? No
Date Returned to Manufacturer12/26/2022
Is the Reporter a Health Professional? No
Date Manufacturer Received11/28/2022
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Reuse
Patient Sequence Number1
Patient Outcome(s) Other;
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