MAUDE Adverse Event Report: STRYKER INSTRUMENTS-KALAMAZOO SILVERGLIDE PROSERIES BIPOLAR FORCEPS, BAYONET, 22CM / 0.7MM TIP; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES

Model Number	6730220007
Medical Device Problem Code	Flaked (1246)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	06/24/2019
Type of Reportable Event	Malfunction
Event or Problem Description
The user facility reported coating coming off the device, posing the risk of material being lost in a surgical site, during preparations before a procedure.There was no patient involvement, no delay, no medical intervention, and no adverse consequences reported with this event.
Event or Problem Description
The user facility reported coating coming off the device, posing the risk of material being lost in a surgical site, during preparations before a procedure.There was no patient involvement, no delay, no medical intervention, and no adverse consequences reported with this event.
Additional Manufacturer Narrative
Manufacture date: follow-up report submitted to document device evaluation results.Product not available.

• Brand Name: SILVERGLIDE PROSERIES BIPOLAR FORCEPS, BAYONET, 22CM / 0.7MM TIP
• Common Device Name: ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES
• Manufacturer (Section D): STRYKER INSTRUMENTS-KALAMAZOO; 4100 east milham avenue; kalamazoo MI 49001
• MDR Report Key: 8811411
• Report Number: 0001811755-2019-02319
• Device Sequence Number: 2457332
• Product Code: GEI
• UDI-Device Identifier: 04546540695949
• UDI-Public: 04546540695949
• Combination Product (Y/N): N
• Initial Reporter State: GA
• Initial Reporter Country: US
• PMA/510(K) Number: K992931
• 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): 05/13/2020

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 Model Number: 6730220007
• Device Catalogue Number: 6730220007
• Device Lot Number: 64557
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 06/25/2019
• Supplement Date Received by Manufacturer: 05/12/2020
• Initial Report FDA Received Date: 07/22/2019
• Supplement Report FDA Received Date: 05/13/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1