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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE SERFAS ENERGY 90-S CRUISE; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES

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STRYKER ENDOSCOPY-SAN JOSE SERFAS ENERGY 90-S CRUISE; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES Back to Search Results
Catalog Number 0279401200
Medical Device Problem Code Material Fragmentation (1261)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 01/09/2026
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 a metal component came off the radio frequency wand inside the patient during a standard shoulder decompression.The metal fragment was retrieved.
 
Additional Manufacturer Narrative
It was reported the device was disposed of.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: material fragmentation probable root cause: non-conforming component, poor assembly process, misuse.Use errors probe used as a tool for mechanical displacement of tissue or bone, or to pry or scrub excessive force used when inserting of removing probe, probe inserted into obstructed passageway, or any forceful impact to the tip of the probe with rigid objects excessive use of device beyond stated lifetime the reported failure mode will be monitored for future reoccurrence.
 
Event or Problem Description
It was reported that a metal component came off the radio frequency wand inside the patient during a standard shoulder decompression.The metal fragment was retrieved.
 
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Brand Name
SERFAS ENERGY 90-S CRUISE
Common Device Name
ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES
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 Key24283802
Report Number0002936485-2026-00070
Device Sequence Number9926921
Product Code GEI
UDI-Device Identifier07613327057034
UDI-Public07613327057034
Combination Product (Y/N)N
Initial Reporter CountryUK
PMA/510(K) Number
K160050
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Health Professional
Initial Reporter Occupation Other Health Care Professional
Type of Report Initial,Followup
Report Date (Section B) 04/14/2026
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 Number0279401200
Device Lot Number25210AE2
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 01/10/2026
Supplement Date Received by Manufacturer03/30/2026
Initial Report FDA Received Date02/06/2026
Supplement Report FDA Received Date04/14/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured07/29/2025
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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