MAUDE Adverse Event Report: STRYKER INSTRUMENTS-PUERTO RICO FEMORAL CANAL TIP, IRRIGATION/SUCTION; LAVAGE, JET

Catalog Number	0210008000
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	05/25/2019
Type of Reportable Event	Malfunction
Event or Problem Description
The user facility reported the tip of the handpiece was found missing after irrigating the femoral canal.After wound exploration and examination of the femoral canal with arthroscopy and fluoroscopic screening revealed there was no retained foreign body.There was no delay or medical intervention required.
Additional Manufacturer Narrative
Additional information:.
Event or Problem Description
The user facility reported the tip of the handpiece was found missing after irrigating the femoral canal.After wound exploration and examination of the femoral canal with arthroscopy and flouroscopic screening revealed there was no retained foreign body.There was no delay or medical intervention required.

• Brand Name: FEMORAL CANAL TIP, IRRIGATION/SUCTION
• Common Device Name: LAVAGE, JET
• Manufacturer (Section D): STRYKER INSTRUMENTS-PUERTO RICO; las palmas industrial park; highway #3, km 130.2; arroyo 00615
• MDR Report Key: 8832345
• Report Number: 0001811755-2019-02572
• Device Sequence Number: 2457273
• Product Code: FQH
• UDI-Device Identifier: 34546540144158
• UDI-Public: 34546540144158
• Combination Product (Y/N): N
• Initial Reporter Country: HK
• PMA/510(K) Number: EXEMPT
• 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): 08/19/2019

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: Health Professional
• Device Catalogue Number: 0210008000
• Device Lot Number: 18095012
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/18/2019
• Initial Date Received by Manufacturer: 07/03/2019
• Supplement Date Received by Manufacturer: 08/08/2019
• Initial Report FDA Received Date: 07/26/2019
• Supplement Report FDA Received Date: 08/19/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1