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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE ALPHAVENT SUTURE ANCHOR 4.75MM PEEK SUTURE ANCHOR WITH 2 STRANDS 1.4MM XBRAID TT; FASTENER, FIXATION, NONDEGRADABLE, SOFT TISSUE

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STRYKER ENDOSCOPY-SAN JOSE ALPHAVENT SUTURE ANCHOR 4.75MM PEEK SUTURE ANCHOR WITH 2 STRANDS 1.4MM XBRAID TT; FASTENER, FIXATION, NONDEGRADABLE, SOFT TISSUE Back to Search Results
Catalog Number 3910-947-021
Medical Device Problem Code Expiration Date Error (2528)
Health Effect - Clinical Codes Insufficient Information (4580); No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 09/16/2025
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 an expired product was used.
 
Additional Manufacturer Narrative
The device will not be returned for investigation.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 product.Probable root cause: application, use past device/packaging shelf life, user contaminates device, rough handling of sterile packaging, use of expired product, other source of contamination introduced to patient during procedure.The reported failure mode will be monitored for future reoccurrence.
 
Event or Problem Description
It was reported that an expired product was used.
 
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Brand Name
ALPHAVENT SUTURE ANCHOR 4.75MM PEEK SUTURE ANCHOR WITH 2 STRANDS 1.4MM XBRAID TT
Common Device Name
FASTENER, FIXATION, NONDEGRADABLE, SOFT TISSUE
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
arsalan rizvi
5900 optical court
san jose, CA 95138
4087542000
MDR Report Key23369385
Report Number0002936485-2025-00869
Device Sequence Number8915785
Product Code MBI
UDI-Device Identifier07613327563054
UDI-Public07613327563054
Combination Product (Y/N)N
Initial Reporter StateIL
Initial Reporter CountryUS
PMA/510(K) Number
K211502
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) 12/29/2025
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 Catalogue Number3910-947-021
Device Lot Number23066AE2
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 09/24/2025
Supplement Date Received by Manufacturer12/22/2025
Initial Report FDA Received Date10/23/2025
Supplement Report FDA Received Date12/29/2025
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured03/07/2023
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)
No
Usage of Device Initial
Patient Sequence Number1
Patient SexUnknown
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