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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE RF 2 PROBES, 90-S MAX; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES

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STRYKER ENDOSCOPY-SAN JOSE RF 2 PROBES, 90-S MAX; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES Back to Search Results
Catalog Number 0279401100
Medical Device Problem Code Continuous Firing (1123)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 09/12/2023
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Additional information will be provided once the investigation has been completed.
 
Event or Problem Description
It was reported that the device continuously activated.
 
Additional Manufacturer Narrative
Alleged failure: it continues to work once the button is released.The failure(s) identified in the investigation is consistent with the complaint record.The probable root cause/s could be a probe short due to a fluid ingress, or an internal leak due to a broken/damaged bond of the suction tubing.The product was returned for investigation and the failure mode will be monitored for future reoccurrence.
 
Event or Problem Description
It was reported that the device continuously activated.
 
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Brand Name
RF 2 PROBES, 90-S MAX
Common Device Name
ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES
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 Key17889985
Report Number0002936485-2023-01017
Device Sequence Number17884092
Product Code GEI
UDI-Device Identifier07613327057027
UDI-Public07613327057027
Combination Product (Y/N)N
Initial Reporter CountryFR
PMA/510(K) Number
K160050
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Health Professional
Initial Reporter Occupation Pharmacist
Type of Report Initial,Followup
Report Date (Section B) 03/04/2024
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 Catalogue Number0279401100
Device Lot Number22126AE2
Was Device Available for Evaluation? Device Returned to Manufacturer
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 09/12/2023
Supplement Date Received by Manufacturer09/12/2023
Initial Report FDA Received Date10/06/2023
Supplement Report FDA Received Date03/04/2024
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured05/06/2022
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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