MAUDE Adverse Event Report: STRYKER INSTRUMENTS-KALAMAZOO MONOPOLAR RETURN ELECTRODE CABLE; PROBE, RADIOFREQUENCY LESION

Catalog Number	0406850200
Medical Device Problem Code	Overheating of Device (1437)
Health Effect - Clinical Code	Burn(s) (1757)
Date of Event	12/25/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
This record is a consolidation of records summarized as a part of the fda voluntary malfunction summary reporting program.Reported events: 1 event was reported for this quarter.Product return status: 1 device investigation type has not yet been determined.Additional information: 1 device is not labeled for single-use, 1 device was not reprocessed and reused.
Event or Problem Description
This report summarizes 1 malfunction event in which the device reportedly overheated, 1 event had the patient receive a burn.
Additional Manufacturer Narrative
This record is a consolidation of records summarized as a part of the fda voluntary malfunction summary reporting program.  supplemental rationale corrected data: 1 previously reported event is included in this follow-up record.  product return status 1 device was not available for evaluation.Device not available for evaluation.
Event or Problem Description
This report summarizes malfunction event in which the device reportedly overheated.1 event had the patient receive a burn.

• Brand Name: MONOPOLAR RETURN ELECTRODE CABLE
• Common Device Name: PROBE, RADIOFREQUENCY LESION
• Manufacturer (Section D): STRYKER INSTRUMENTS-KALAMAZOO; 4100 east milham avenue; kalamazoo MI 49001
• MDR Report Key: 8285183
• Report Number: 0001811755-2019-00395
• Device Sequence Number: 13939860
• Product Code: GXI
• UDI-Device Identifier: 04546540904898
• UDI-Public: 04546540904898
• Combination Product (Y/N): N
• Initial Reporter State: MI
• Initial Reporter Country: US
• Number of Events Summarized: 1
• 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): 06/28/2019

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: 0406850200
• Device Lot Number: VMSR
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 12/25/2018
• Supplement Date Received by Manufacturer: 12/25/2018
• Initial Report FDA Received Date: 01/29/2019
• Supplement Report FDA Received Date: 06/28/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1