MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE PKG, 5MM PEEK HANDLE, 45CM; ENDOSCOPIC GRASPING/CUTTING INSTRUMENT, NON-POWERED

Catalog Number 0250181164

Device Problem Device Operates Differently Than Expected (2913)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 12/09/2017

Event Type  malfunction  

Manufacturer Narrative

Mfg date: the device manufacture date is not known at this time.However, should it become available it will be provided in future reports.Additional information will be provided once the investigation has been completed.(b)(4).

Event Description

It was reported that the insulation was compromised.

Manufacturer Narrative

The product was returned for investigation and the reported failure mode was confirmed.Alleged failure: burn on insulation at shaft.Confirmed failure: burn on insulation at shaft.The probable root causes could be user misuse, excessive force, normal wear, or improper sterilization methods.The reported failure mode will be monitored for future reoccurrence.Mfg date: manufacture date is not known.Gtin #: (b)(4).

Event Description

It was reported that the insulation was compromised.

• Brand Name: PKG, 5MM PEEK HANDLE, 45CM
• Type of Device: ENDOSCOPIC GRASPING/CUTTING INSTRUMENT, NON-POWERED
• Manufacturer (Section D): STRYKER ENDOSCOPY-SAN JOSE; 5900 optical court; san jose CA 95138
• MDR Report Key: 7165372
• MDR Text Key: 96472386
• Report Number: 0002936485-2018-00021
• Device Sequence Number: 1
• Product Code: OCZ
• Combination Product (y/n): N
• PMA/PMN Number: K973259
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 03/23/2018

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 Number: 0250181164
• Device Lot Number: ¿1041063D¿
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/11/2017
• Initial Date Manufacturer Received: 12/09/2017
• Initial Date FDA Received: 01/04/2018
• Supplement Dates Manufacturer Received: 12/09/2017
• Supplement Dates FDA Received: 03/23/2018
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1