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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER INSTRUMENTS-KALAMAZOO MEDIUM STRAIGHT ATTACHMENT; DRILL, SURGICAL, ENT (ELECTRIC OR PNEUMATIC) INCLUDING HANDPIECE
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STRYKER INSTRUMENTS-KALAMAZOO MEDIUM STRAIGHT ATTACHMENT; DRILL, SURGICAL, ENT (ELECTRIC OR PNEUMATIC) INCLUDING HANDPIECE Back to Search Results
Model Number 5100120450
Medical Device Problem Code Overheating of Device (1437)
Health Effect - Clinical Codes No Known Impact Or Consequence To Patient (2692); No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 07/27/2020
Type of Reportable Event Malfunction
Event or Problem Description
The manufacturer sales representative reported that the device overheated at the user facility.There was no known patient impact, no known delay, no known medical intervention, and no known adverse consequences.
 
Additional Manufacturer Narrative
Follow-up report submitted to document device results.
 
Event or Problem Description
The manufacturer sales representative reported that the device overheated at the user facility.There was no known patient impact, no known delay, no known medical intervention, and no known adverse consequences.
 
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Brand Name
MEDIUM STRAIGHT ATTACHMENT
Common Device Name
DRILL, SURGICAL, ENT (ELECTRIC OR PNEUMATIC) INCLUDING HANDPIECE
Manufacturer (Section D)
STRYKER INSTRUMENTS-KALAMAZOO
4100 east milham avenue
kalamazoo MI 49001
MDR Report Key10434250
Report Number0001811755-2020-02220
Device Sequence Number2828467
Product Code ERL
UDI-Device Identifier04546540369956
UDI-Public04546540369956
Combination Product (Y/N)N
Initial Reporter StateCA
Initial Reporter CountryUS
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source company representative
Initial Reporter Occupation Other
Type of Report Initial,Followup
Report Date (Section B) 10/09/2020
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
Operator of Device Health Professional
Device Model Number5100120450
Device Catalogue Number5100120450
Device Lot NumberUNKNOWN
Was Device Available for Evaluation? Yes
Initial Date Received by Manufacturer 07/27/2020
Supplement Date Received by Manufacturer10/08/2020
Initial Report FDA Received Date08/20/2020
Supplement Report FDA Received Date10/09/2020
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)		 No
Patient Sequence Number1
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