MAUDE Adverse Event Report: STRYKER INSTRUMENTS-A DIVISION OF STRYKER CORP RECIPROCATING BLADE HEAVY DUTY (87.9 X 1.27 X 12.2MM); BLADE, SAW, GENERAL & PLASTIC SURGERY,SURGICAL

Model Number	5301020061S1
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/21/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
A follow up report will be filed once the quality investigation is complete.Awaiting device return.
Event or Problem Description
It was reported that three blades broke during a total hip arthroplasty procedure.It was further reported there was a 5 minute delay to obtain a new blade.It was also reported that there were no adverse consequences and the procedure was completed successfully.This report is for the third blade that broke.
Event or Problem Description
It was reported that three blades broke during a total hip arthroplasty procedure.It was further reported there was a 5 minute delay to obtain a new blade.It was also reported that there were no adverse consequences and the procedure was completed successfully.This report is for the third blade that broke.
Additional Manufacturer Narrative
H6: the quality investigation is complete.

• Brand Name: RECIPROCATING BLADE HEAVY DUTY (87.9 X 1.27 X 12.2MM)
• Common Device Name: BLADE, SAW, GENERAL & PLASTIC SURGERY,SURGICAL
• Manufacturer (Section D): STRYKER INSTRUMENTS-A DIVISION OF STRYKER CORP; 1941 stryker way; portage MI 49002
• MDR Report Key: 12172967
• Report Number: 3015967359-2021-01411
• Device Sequence Number: 13826073
• Product Code: GFA
• UDI-Device Identifier: 07613153095606
• UDI-Public: 07613153095606
• Combination Product (Y/N): N
• Initial Reporter State: GA
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Nurse
• Type of Report: Initial,Followup
• Report Date (Section B): 08/06/2021

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
• Operator of Device: Health Professional
• Device Expiration Date: 08/01/2025
• Device Model Number: 5301020061S1
• Device Catalogue Number: 5301020061S1
• Device Lot Number: 20240017
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/06/2021
• Initial Date Received by Manufacturer: 06/21/2021
• Supplement Date Received by Manufacturer: 08/05/2021
• Initial Report FDA Received Date: 07/15/2021
• Supplement Report FDA Received Date: 08/06/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1