MAUDE Adverse Event Report: STRYKER INSTRUMENTS-KALAMAZOO SUCTION TUBE, 2.7MM RIGHT POSTERIOR FOSSA; NEUROLOGICAL STEREOTAXIC INSTRUMENT

Catalog Number	6001-088-227
Medical Device Problem Code	Disassembly (1168)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	02/13/2017
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that during the service evaluation process conducted at the manufacturer facility the led lens of the device was identified as broken off.No patient involvement or procedural delays were associated with the event as the event occurred during the evaluation process.
Additional Manufacturer Narrative
The reported event that the led cover is missing was confirmed through the device inspection.Any physical impact to the device can cause the reported event.
Event or Problem Description
It was reported that during the service evaluation process conducted at the manufacturer facility the led lens of the device was identified as broken off.No patient involvement or procedural delays were associated with the event as the event occurred during the evaluation process.

• Brand Name: SUCTION TUBE, 2.7MM RIGHT POSTERIOR FOSSA
• Common Device Name: NEUROLOGICAL STEREOTAXIC INSTRUMENT
• Manufacturer (Section D): STRYKER INSTRUMENTS-KALAMAZOO; 4100 east milham avenue; kalamazoo MI 49001
• MDR Report Key: 6394715
• Report Number: 0001811755-2017-00735
• Device Sequence Number: 19176905
• Product Code: HAW
• UDI-Device Identifier: 04546540245854
• UDI-Public: (01)04546540245854
• Combination Product (Y/N): N
• Initial Reporter State: MI
• Initial Reporter Country: US
• PMA/510(K) Number: K002732
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 04/28/2017

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: Other
• Device Catalogue Number: 6001-088-227
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/13/2017
• Type of Report(Section G): FDA Requested
• Initial Date Received by Manufacturer: 02/13/2017
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 03/10/2017
• Supplement Report FDA Received Date: 04/28/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1