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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE PKG., AGG. PLUS SHAVER BLADE, F - SERIES - 5.0MM; BLADE, SAW, GENERAL & PLASTIC SURGERY, SURGICAL

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STRYKER ENDOSCOPY-SAN JOSE PKG., AGG. PLUS SHAVER BLADE, F - SERIES - 5.0MM; BLADE, SAW, GENERAL & PLASTIC SURGERY, SURGICAL Back to Search Results
Catalog Number 0375554000
Medical Device Problem Code Contamination /Decontamination Problem (2895)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 04/24/2023
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that there was foreign material inside the sterile packaging.
 
Additional Manufacturer Narrative
Additional information will be provided once the investigation has been completed.
 
Additional Manufacturer Narrative
Alleged failure: there is a plastic piece at the mouth of the sealed shaver.The failure(s) identified in the investigation is consistent with the complaint record.The probable root cause/s could be improper cleaning process, qc incoming, and in-process inspections.The material was not removed during the cleaning process.An nc was opened to address the issue.The product was returned for investigation and the failure mode will be monitored for future reoccurrence.
 
Event or Problem Description
It was reported that there was foreign material inside the sterile packaging.
 
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Brand Name
PKG., AGG. PLUS SHAVER BLADE, F - SERIES - 5.0MM
Common Device Name
BLADE, SAW, GENERAL & PLASTIC SURGERY, SURGICAL
Manufacturer (Section D)
STRYKER ENDOSCOPY-SAN JOSE
5900 optical court
san jose CA 95138
Manufacturer (Section G)
STRYKER ENDOSCOPY-SAN JOSE
5900 optical court
san jose CA 95138
Manufacturer Contact
lucas wolski
5900 optical court
san jose, CA 95138
4087542000
MDR Report Key17005183
Report Number0002936485-2023-00522
Device Sequence Number15245944
Product Code GFA
UDI-Device Identifier37613327061889
UDI-Public37613327061889
Combination Product (Y/N)N
Initial Reporter CountrySZ
PMA/510(K) Number
EXEMPT
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Other
Initial Reporter Occupation Other
Type of Report Initial,Followup
Report Date (Section B) 11/30/2023
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 Other
Device Catalogue Number0375554000
Device Lot Number22294CE2
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer05/23/2023
Is the Reporter a Health Professional? No
Type of Report(Section G)Follow-Up
Initial Date Received by Manufacturer 05/03/2023
Supplement Date Received by Manufacturer05/03/2023
Initial Report FDA Received Date05/25/2023
Supplement Report FDA Received Date11/30/2023
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured10/21/2022
Is the Device Labeled for Single Use? (Y/N) Yes
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Usage of Device Initial
Patient Sequence Number1
Patient SexUnknown
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