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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER-ENDOSCOPY LAKELAND 5300; LAPAROSCOPE, GENERAL & PLASTIC SURGERY, REPROCESSED

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STRYKER-ENDOSCOPY LAKELAND 5300; LAPAROSCOPE, GENERAL & PLASTIC SURGERY, REPROCESSED Back to Search Results
Model Number CTI-512N
Medical Device Problem Codes Break (1069); Use of Device Problem (1670)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 01/07/2026
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
The device was returned to stryker sustainability solutions for evaluation.Upon inspection of the received complaint device the returned complaint device was received with the stryker sustainability packaging.There was evidence of bio-burden on the device.The device was sent back put together and broken on the handle.Where the shaft and handle meet the plastic was broken off.The device inspection indicated that the complaint was confirmed for the reported failure mode.A review of the dhr supports that the device met all inspection and test criteria prior to release from stryker.The reported event could be attributed to: excessive force, contact of needle point with hard object, shipping/handling damage or extreme conditions, attempting to bend or otherwise alter the shape of the device/shaft.The instructions for use (ifu) state: "before beginning the procedure, verify overall compatibility of all instruments and accessories." "inspect the instrument for overall condition and physical integrity.Do not use the instrument if any damage is noted.Return the instrument and packaging to stryker sustainability solutions if it is not in acceptable condition for surgery." the reported event will continue to be monitored through post-market surveillance.
 
Event or Problem Description
It was reported that a suture passer broke during use.There was no patient injury, medical intervention, or extended procedure time reported.These are commonly used devices that are readily available.
 
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Brand Name
NA
Common Device Name
LAPAROSCOPE, GENERAL & PLASTIC SURGERY, REPROCESSED
Manufacturer (Section D)
STRYKER-ENDOSCOPY LAKELAND 5300
5300 region ct
lakeland FL 33815
Manufacturer (Section G)
STRYKER-ENDOSCOPY LAKELAND 5300
5300 region ct
lakeland FL 33815
Manufacturer Contact
arsalan rizvi
1810 w. drake drive
tempe, AZ 85283
8888883433
MDR Report Key24560997
Report Number0001056128-2026-00018
Device Sequence Number15812565
Product Code NLM
UDI-Device Identifier00885825013318
UDI-Public00885825013318
Combination Product (Y/N)N
Initial Reporter StateIL
Initial Reporter CountryUS
PMA/510(K) Number
K053585
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
Report Date (Section B) 03/10/2026
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 Model NumberCTI-512N
Device Catalogue NumberCTI-512N
Device Lot Number0000991790
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer02/10/2026
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 03/09/2026
Initial Report FDA Received Date03/10/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured09/10/2025
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)
Yes
Usage of Device Reuse
Patient Sequence Number1
Patient SexUnknown
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