MAUDE Adverse Event Report: Stryker-Endoscopy Lakeland 5300; single-use reprocessed ultrasonic surgical instruments

Model Number	HAR1136
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/22/2026
Type of Reportable Event	Malfunction

• Brand Name: NA
• Common Device Name: single-use reprocessed ultrasonic surgical instruments
• 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 ; +1(888)888-3433
• MDR Report Key: 50906261
• Report Number: 0001056128-2026-00076
• Device Sequence Number: 6076553
• Product Code: NLQ
• UDI-Device Identifier: 07613327586589
• UDI-Public: (01)07613327586589(17)290611(10)17836215
• Combination Product (Y/N): N
• Initial Reporter State: IL
• Initial Reporter Country: US
• PMA/510(K) Number: K233471
• Number of Events Summarized: 1
• 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): 09/25/2026

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 Number: HAR1136
• Device Catalogue Number: HAR1136
• Device Lot Number: 17836215
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 08/24/2026
• Is the Reporter a Health Professional?: Yes
• Initial Date Received by Manufacturer: 09/21/2026
• Initial Report FDA Received Date: 09/25/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/11/2026
• 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 Number: 1
• Patient Age: 64 YR
• Patient Sex: Male