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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE 3.9MM OMEGA DRILL; BIT, DRILL

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STRYKER ENDOSCOPY-SAN JOSE 3.9MM OMEGA DRILL; BIT, DRILL Back to Search Results
Catalog Number 3910-947-204
Medical Device Problem Code Expiration Date Error (2528)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 07/25/2025
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Additional information will be provided once the investigation has been completed.The device manufacturer date is not known at this time.However, should it become available it will be provided in future reports.
 
Event or Problem Description
It was reported that the rep opened an expired drill bit and put it in the instrument pan and had it sterilized for a case.
 
Event or Problem Description
It was reported that the rep opened an expired drill bit and put it in the instrument pan and had it sterilized for a case.
 
Additional Manufacturer Narrative
The device was disposed of and was not returned.This complaint investigation was closed based on the device not received, therefore the reported failure mode was not confirmed.In the event that the device is received, the complaint will be reopened and the investigation will be updated with new results.Alleged failure: expired drill bit.Probable root cause: application: distribution inefficient, sat too long in inventory before being shipped to customer.The reported failure mode will be monitored for future reoccurrence.
 
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Brand Name
3.9MM OMEGA DRILL
Common Device Name
BIT, DRILL
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
andy dobos
5900 optical court
san jose, CA 95138
4087542000
MDR Report Key22877117
Report Number0002936485-2025-00721
Device Sequence Number20284505
Product Code HTW
UDI-Device Identifier07613327550078
UDI-Public07613327550078
Combination Product (Y/N)N
Initial Reporter StateOK
Initial Reporter CountryUS
PMA/510(K) Number
EXEMPT
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Company Representative
Initial Reporter Occupation Other
Type of Report Initial,Followup
Report Date (Section B) 10/23/2025
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 Other
Device Catalogue Number3910-947-204
Device Lot Number007744
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Type of Report(Section G)Follow-Up
Initial Date Received by Manufacturer 07/25/2025
Supplement Date Received by Manufacturer10/02/2025
Initial Report FDA Received Date08/22/2025
Supplement Report FDA Received Date10/23/2025
Was Device Evaluated by Manufacturer? (Y/N) No
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 Reuse
Patient Sequence Number1
Patient SexUnknown
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