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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE PKG, 22 FR, COLLINGS KNIFE ELECTRODE COPE AND ACCESSORIES, FLEXIBLE/RIGID
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STRYKER ENDOSCOPY-SAN JOSE PKG, 22 FR, COLLINGS KNIFE ELECTRODE COPE AND ACCESSORIES, FLEXIBLE/RIGID Back to Search Results
Catalog Number 0504990800
Device Problem Contamination /Decontamination Problem (2895)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Date 09/26/2018
Event Type  Malfunction  
Manufacturer Narrative

The device manufacture date is not known at this time. However, should it become available it will be provided in future reports. Additional information will be provided once the investigation has been completed.

 
Event Description

It was reported that there was a breach in the sterile barrier.

 
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Brand NamePKG, 22 FR, COLLINGS KNIFE ELECTRODE
Type of DeviceCOPE AND ACCESSORIES, FLEXIBLE/RIGID
Manufacturer (Section D)
STRYKER ENDOSCOPY-SAN JOSE
5900 optical court
san jose CA 95138
Manufacturer (Section G)
STRYKER ENDOSCOPY-SAN JOSE
5900 optical court
san jose CA 95138
Manufacturer Contact
chester rebugio
5900 optical court
san jose, CA 95138
4087542000
MDR Report Key7991484
MDR Text Key124673726
Report Number0002936485-2018-00657
Device Sequence Number1
Product Code FAJ
Combination Product (Y/N)N
Reporter Country CodeCN
PMA/PMN NumberK040390
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type COMPANY REPRESENTATIVE
Reporter Occupation
Type of Report Initial,Followup
Report Date 01/31/2019
1 Device Was Involved in the Event
0 PatientS WERE Involved in the Event:
Date FDA Received10/22/2018
Is This An Adverse Event Report? No
Is This A Product Problem Report? Yes
Device Operator OTHER
Device Catalogue Number0504990800
Device LOT NumberSTRKN01
Was Device Available For Evaluation? Device Returned To Manufacturer
Date Returned to Manufacturer12/13/2018
Is The Reporter A Health Professional? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received09/26/2018
Was Device Evaluated By Manufacturer? Yes
Is The Device Single Use? Yes
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

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