MAUDE Adverse Event Report: STRYKER INSTRUMENTS-KALAMAZOO NGENIUS TIBIA TRACKER; ORTHOPEDIC STEREOTAXIC INSTRUMENT

Catalog Number	6003-024-000
Medical Device Problem Code	Disassembly (1168)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	02/23/2017
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the diode of the device was found to be missing during set-up for a procedure conducted at the user facility.No patient involvement or procedural delays were reported with this event.
Event or Problem Description
It was reported that the diode of the device was found to be missing during set-up for a procedure conducted at the user facility.No patient involvement or procedural delays were reported with this event.

• Brand Name: NGENIUS TIBIA TRACKER
• Common Device Name: ORTHOPEDIC STEREOTAXIC INSTRUMENT
• Manufacturer (Section D): STRYKER INSTRUMENTS-KALAMAZOO; 4100 east milham avenue; kalamazoo MI 49001
• MDR Report Key: 6427111
• Report Number: 0001811755-2017-00786
• Device Sequence Number: 913296
• Product Code: OLO
• UDI-Device Identifier: 04546540678676
• UDI-Public: (01)04546540678676
• Combination Product (Y/N): N
• Initial Reporter State: CO
• Initial Reporter Country: US
• PMA/510(K) Number: K022579
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: user facility
• 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: Health Professional
• Device Catalogue Number: 6003-024-000
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/06/2017
• Type of Report(Section G): FDA Requested
• Initial Date Received by Manufacturer: 02/23/2017
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 03/23/2017
• 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