MAUDE Adverse Event Report: STRYKER-ENDOSCOPY LAKELAND 5300; ELECTROSURGICAL, CUTTING & COAGULATION ACCESSORIES, LAPAROSCOPIC & ENDOSCOPIC, R

Model Number	LF1937
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/17/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The device was returned to stryker sustainability solutions for evaluation.Upon inspection of the received complaint device, the handle, blade trigger, button, shaft, and part of jaws appeared to be intact.Visual inspection of the jaws reveals the top jaw pads was separated from the jaw skeleton and hanging by the wire.Damage to the over mold plastic was observed.A 10x microscope was used to get a closer look at the mold and jaws.The skeleton jaw had a gouge.Most likely jaw grasped something harder than tissue and caused damaged to the jaws.A review of the dhr supports that the device met all inspection and test criteria prior to release from stryker.Therefore, the most likely root causes are: grasping on to too much or inappropriate tissue types or staples.Improperly forcing open the jaws of the device.Attempting to remove the device from the trocar with the jaws in the open position.The instructions for use (ifu) state: in minimally invasive surgery, inspect the outer surfaces of the instrument before insertion through the cannula to ensure that there are no rough or sharp edges that could damage tissue.Remove instrument from tray by firmly pulling on the handle.Do not pull on the instrument jaws or cable.Use the appropriately sized trocar to allow for easy insertion and extraction of the instrument.Carefully insert and withdraw the instrument through the cannula to avoid damage to the device and/or injury to the patient.Close jaws using device lever before insertion/extraction in the trocar.- notice ¿ do not turn the rotation wheel when the lever is latched.Product damage may occur.Notice ¿ do not engage the cutting mechanism over clips, staples, or other metal objects as damage to the cutter may occur.Do not attempt to clean the instrument jaws by activating the instrument on wet gauze.Product damage may occur.Do not clean the instrument jaws with a scratch pad or other abrasives.The reported event will continue to be monitored through post-market surveillance.
Event or Problem Description
It was reported that towards the end of the case, the doctor went to cut tissue and the tip of the ligasure fell off.The tip of ligasure stayed hanging on device.There was no patient injury, medical intervention, or extended procedure time reported.These are commonly used devices that are readily available.

• Brand Name: NA
• Common Device Name: ELECTROSURGICAL, CUTTING & COAGULATION ACCESSORIES, LAPAROSCOPIC & ENDOSCOPIC, R
• Manufacturer (Section D): STRYKER-ENDOSCOPY LAKELAND 5300; 5300 region ct; lakeland FL 33815
• Manufacturer (Section G): STRYKER-ENDOSCOPY LAKELAND 5300; 5300 region ct; lakeland FL 33815
• Manufacturer Contact: andy dobos ; 1810 w. drake drive; tempe, AZ 85283 ; 8888883433
• MDR Report Key: 19987460
• Report Number: 0001056128-2024-00080
• Device Sequence Number: 7087290
• Product Code: NUJ
• UDI-Device Identifier: 07613327504897
• UDI-Public: 07613327504897
• Combination Product (Y/N): N
• Initial Reporter State: ID
• Initial Reporter Country: US
• PMA/510(K) Number: K180499
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 08/14/2024

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 Expiration Date: 06/13/2026
• Device Model Number: LF1937
• Device Catalogue Number: LF1937
• Device Lot Number: 15008208
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/25/2024
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 07/17/2024
• Initial Report FDA Received Date: 08/14/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/13/2023
• 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): Yes
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown