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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE PKG. ASSY. SUCTION IRRIGATOR 2; LAPAROSCOPE, GENERAL & PLASTIC SURGERY

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STRYKER ENDOSCOPY-SAN JOSE PKG. ASSY. SUCTION IRRIGATOR 2; LAPAROSCOPE, GENERAL & PLASTIC SURGERY Back to Search Results
Catalog Number 0250070500
Medical Device Problem Code Device Contaminated During Manufacture or Shipping (2969)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 12/03/2025
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that one unit was observed to have a blue fleck on the inside of the packaging, and the other unit had a blue smear on the part itself, as well as a fleck of something on the red knob.
 
Additional Manufacturer Narrative
Additional information will be provided once the investigation has been completed.
 
Additional Manufacturer Narrative
The device was not 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: blue fleck on the inside of the packaging.Probable root cause: 1.Incorrect or inadequate packaging.2.Severe shipping conditions.3.User error.The reported failure mode will be monitored for future reoccurrence.
 
Event or Problem Description
It was reported that one unit was observed to have a blue fleck on the inside of the packaging, and the other unit had a blue smear on the part itself as well as a fleck of something on the red knob.
 
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Brand Name
PKG. ASSY. SUCTION IRRIGATOR 2
Common Device Name
LAPAROSCOPE, GENERAL & PLASTIC SURGERY
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 Key23884364
Report Number0002936485-2025-01018
Device Sequence Number14619940
Product Code GCJ
UDI-Device Identifier37613327061391
UDI-Public37613327061391
Combination Product (Y/N)N
Initial Reporter CountryCA
PMA/510(K) Number
EXEMPT
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Consumer
Initial Reporter Occupation Other
Type of Report Initial,Followup
Report Date (Section B) 04/21/2026
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 Number0250070500
Device Lot Number25219FG2
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 12/03/2025
Supplement Date Received by Manufacturer04/07/2026
Initial Report FDA Received Date12/23/2025
Supplement Report FDA Received Date04/21/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured08/07/2025
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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