MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE PKG, 90 DEG CUTTING LOOP ELECTRODE 27FR., .014 WIRE; ELECTRODE, ELECTROSURGICAL, ACTIVE, UROLOGICAL

Catalog Number 0504881314

Device Problems Detachment of Device or Device Component (2907); Electrical Power Problem (2925)

Patient Problems Insufficient Information (4580); No Clinical Signs, Symptoms or Conditions (4582)

Event Date 10/22/2020

Event Type  malfunction  

Manufacturer Narrative

Additional information will be provided once the investigation has been completed.The device manufacture 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 cutting loop detached from the probe.The detached piece was retrieved.

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: electrode would melt the adhesive.Probable root cause: generator power malfunction.Material/design error.Conductive irrigant used.Improper use with another electromedical device.Use error.The reported failure mode will be monitored for future reoccurrence.The device manufacture date is not known h3 other text : 81.

Event Description

It was reported that the cutting loop detached from the probe.The detached piece was retrieved.

• Brand Name: PKG, 90 DEG CUTTING LOOP ELECTRODE 27FR., .014 WIRE
• Type of Device: ELECTRODE, ELECTROSURGICAL, ACTIVE, UROLOGICAL
• Manufacturer (Section D): STRYKER ENDOSCOPY-SAN JOSE; 5900 optical court; san jose CA 95138
• MDR Report Key: 10847495
• MDR Text Key: 217703912
• Report Number: 0002936485-2020-00467
• Device Sequence Number: 1
• Product Code: FAS
• UDI-Device Identifier: 37613327055512
• UDI-Public: 37613327055512
• Combination Product (y/n): N
• PMA/PMN Number: K040390
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 06/04/2021

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: Health Professional
• Device Catalogue Number: 0504881314
• Device Lot Number: STENJC02
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 10/22/2020
• Initial Date FDA Received: 11/16/2020
• Supplement Dates Manufacturer Received: 10/22/2020
• Supplement Dates FDA Received: 06/04/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1