MAUDE Adverse Event Report: STRYKER INSTRUMENTS-KALAMAZOO DUAL TRIGGER ROTARY HANDPIECE; INSTRUMENT, SURGICAL, ORTHOPEDIC, AC-POWERED MOTOR AND ACCESSORY/ATTACHMENT

Catalog Number	6205000000
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	03/02/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
This mdr report is part of the malfunction summary reporting program, exemption number e2015055.Reported events: three (3) events were reported for this quarter.Product return status: three (3) devices were received for evaluation.Evaluation status: two (2) events were confirmed during testing.Two (2) devices were found to be affected by fractured or missing components.One device evaluation is in progress.Product disposition: the devices were repaired and returned to the user facility.Additional information: there were no remedial actions taken on this device.This device is not labeled for single-use.
Event or Problem Description
This report summarizes 3 malfunction events in which the device had a component detach.Three (3) events had no patient involvement; no patient impact.
Additional Manufacturer Narrative
This mdr report is part of the malfunction summary reporting program, exemption number e2015055.Supplemental rationale: 1 previously reported event is included in this follow-up record.Evaluation status: 1 reported event was confirmed during testing.1 device was found to be affected by missing retaining pins and damage to the front end.  1 device is not labeled for single-use.1 device was not reprocessed and reused.
Event or Problem Description
This report summarizes 3 malfunction events in which the device had a component detach.3 events had no patient involvement; no patient impact.

• Brand Name: DUAL TRIGGER ROTARY HANDPIECE
• Common Device Name: INSTRUMENT, SURGICAL, ORTHOPEDIC, AC-POWERED MOTOR AND ACCESSORY/ATTACHMENT
• Manufacturer (Section D): STRYKER INSTRUMENTS-KALAMAZOO; 4100 east milham avenue; kalamazoo MI 49001
• MDR Report Key: 7715082
• Report Number: 0001811755-2018-01316
• Device Sequence Number: 1015370
• Product Code: HWE
• UDI-Device Identifier: 07613154392698
• UDI-Public: 07613154392698
• Combination Product (Y/N): N
• Initial Reporter State: MI
• Initial Reporter Country: US
• Number of Events Summarized: 3
• Summary Report (Y/N): Y
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 10/29/2018

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: No Information
• Device Catalogue Number: 6205000000
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 03/02/2018
• Supplement Date Received by Manufacturer: 03/02/2018
• Initial Report FDA Received Date: 07/24/2018
• Supplement Report FDA Received Date: 10/29/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1