MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE CONNECTED OR CART, 120 V; CARDIOPULMONARY EMERGENCY CART

Model Number 240099155

Device Problems No Display/Image (1183); Loss of Power (1475)

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

Event Date 01/19/2021

Event Type  malfunction  

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 there was loss of image.

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.The reported failure mode will be monitored for future reoccurrence.Alleged failure: hub lost power probable root cause: ¿ overloading the cart.¿ use error.Manufacturing date is unknown h3 other text : 81.

Event Description

It was reported that there was loss of image.

• Brand Name: CONNECTED OR CART, 120 V
• Type of Device: CARDIOPULMONARY EMERGENCY CART
• Manufacturer (Section D): STRYKER ENDOSCOPY-SAN JOSE; 5900 optical court; san jose CA 95138
• MDR Report Key: 11338486
• MDR Text Key: 233731081
• Report Number: 0002936485-2021-00092
• Device Sequence Number: 1
• Product Code: BZN
• UDI-Device Identifier: 00858701006360
• UDI-Public: 00858701006360
• Combination Product (y/n): N
• PMA/PMN Number: K082813
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 04/11/2021

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 Model Number: 240099155
• Device Catalogue Number: 0240099155
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 01/19/2021
• Initial Date FDA Received: 02/17/2021
• Supplement Dates Manufacturer Received: 01/19/2021
• Supplement Dates FDA Received: 04/11/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1