MAUDE Adverse Event Report: KARL STORZ SE & CO. KG CLICKLINE PLASTIC HANDLE

Model Number	33126
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Codes	Insufficient Information (4580); No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/17/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The affected device has been requested for investigation by the manufacturer.The device was not yet returned for investigation.The event is filed under internal karl storz complaint id: (b)(4).
Event or Problem Description
It was reported that the device broke prior to use, proximal end of sheath snapped inside handle.No patient involvement.Broken during set up for procedure, 2-minute delay to procedure.New set was used, and procedures continued.Since no patient involvement and no injury to patient.Cross reference mdr: 9610617-2025-00373.
Additional Manufacturer Narrative
The device in question was returned to the manufacturer on march 5,2025.This information is reflected in section d9.The evaluation is anticipated, but not yet begun.The investigation will be performed by a designated karl storz employee.The event is filed under internal karl storz complaint id: (b)(4).
Additional Manufacturer Narrative
Device evaluation: the customer's description could be confirmed: the proximal end of the spacer is broken off.This damage is likely due to the age of the shaft and the presumed number of reprocessing cycles, which may have altered the material properties.Additionally, the breakage may have been caused by lateral mechanical force acting on the spacer, indicating user error.The investigation did not reveal any root cause related to the labelling, the device, or its history.All production-related quality checks were passed, and no non-conformities were identified in the manufacturing records the event is filed under internal karl storz complaint id: (b)(4).

• Brand Name: CLICKLINE PLASTIC HANDLE
• Common Device Name: CLICKLINE PLASTIC HANDLE
• Manufacturer (Section D): KARL STORZ SE & CO. KG; dr.-karl-storz-strasse 34; tuttlingen, 78532 ; GM 78532
• Manufacturer (Section G): KARL STORZ SE & CO. KG; dr.-karl-storz-strasse 34; tuttlingen, 78532 ; GM 78532
• Manufacturer Contact: anja fair ; 2151 e grand ave; el segundo, CA 90245
• MDR Report Key: 21531718
• Report Number: 9610617-2025-00371
• Device Sequence Number: 15387428
• Product Code: GCJ
• UDI-Device Identifier: 04048551125113
• UDI-Public: 04048551125113
• Combination Product (Y/N): N
• Initial Reporter Country: UK
• PMA/510(K) Number: K935071
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,User Facility,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 10/13/2025

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 Model Number: 33126
• Device Catalogue Number: 33126
• Device Lot Number: TQ06
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/17/2025
• Supplement Date Received by Manufacturer: 03/05/2025; 09/19/2025
• Initial Report FDA Received Date: 03/05/2025
• Supplement Report FDA Received Date: 03/25/2025; 10/15/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Unknown