| Brand Name | DISP. 34X4, 1BLA, 2PRT, QUICK CONNECT |
| Common Device Name | Tourniquet, Pneumatic |
| Manufacturer (Section D) |
| Stryker Instruments-a division of Stryker Corp |
| 1941 stryker way |
| portage MI 49002 |
|
| Manufacturer (Section G) |
| Stryker Instruments-Puerto Rico |
| las palmas industrial park |
| highway #3, km 130.2 |
| arroyo 00615 |
|
PR
00615
|
|
| Manufacturer Contact |
|
kelsey
barla
|
| 1941 stryker way |
| portage, MI 49002
|
|
+1(269)323-7700
|
|
| MDR Report Key | 24697252 |
| Report Number | 3015967359-2026-00197 |
| Device Sequence Number | 18757760 |
| Product Code |
KCY
|
| UDI-Device Identifier | 07613154599479 |
| UDI-Public | (01)07613154599479(17)270516(10)2025052308 |
| Combination Product (Y/N) | N |
| Initial Reporter State | VA |
| Initial Reporter Country | US |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Company Representative |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
08/11/2026 |
| 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
|
| Device Catalogue Number | 5921034235 |
| Device Lot Number | 2025052308 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Was the Report Sent to FDA? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 03/10/2026 |
| Supplement Date Received by Manufacturer | 03/10/2026
|
| Initial Report FDA Received Date | 03/26/2026 |
| Supplement Report FDA Received Date | 08/11/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 05/16/2025 |
| 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 Number | 1 |
| Patient Sex | Unknown |
|
|