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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE PKG, ASSY, TITANIUM INTRALINE ANCHOR, 5.5MM W/NEEDLES; SCREW, FIXATION, BONE

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STRYKER ENDOSCOPY-SAN JOSE PKG, ASSY, TITANIUM INTRALINE ANCHOR, 5.5MM W/NEEDLES; SCREW, FIXATION, BONE Back to Search Results
Model Number 3910-400-055
Device Problems Device Contamination with Chemical or Other Material (2944); Packaging Problem (3007)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 04/14/2021
Event Type  malfunction  
Manufacturer Narrative
Additional information will be provided once the investigation has been completed.
 
Event Description
It was reported that there was foreign material in the sterile packaging.
 
Event Description
It was reported that there was foreign material in the sterile packaging.
 
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: packaging compromised.Probable root cause: process uncontrolled environmental conditions.The reported failure mode will be monitored for future reoccurrence.H3 other text : 81.
 
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Brand Name
PKG, ASSY, TITANIUM INTRALINE ANCHOR, 5.5MM W/NEEDLES
Type of Device
SCREW, FIXATION, BONE
Manufacturer (Section D)
STRYKER ENDOSCOPY-SAN JOSE
5900 optical court
san jose CA 95138
MDR Report Key11805434
MDR Text Key252755679
Report Number0002936485-2021-00255
Device Sequence Number1
Product Code HWC
UDI-Device Identifier07613154890071
UDI-Public07613154890071
Combination Product (y/n)N
PMA/PMN Number
K071157
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative
Type of Report Initial,Followup
Report Date 06/10/2021
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 Number3910-400-055
Device Catalogue Number3910-400-055
Device Lot NumberUNKNOWN
Was Device Available for Evaluation? No
Initial Date Manufacturer Received 04/16/2021
Initial Date FDA Received05/11/2021
Supplement Dates Manufacturer Received04/16/2021
Supplement Dates FDA Received06/10/2021
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
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