MAUDE Adverse Event Report: STRYKER INSTRUMENTS-KALAMAZOO PERFORMANCE SERIES SAGITTAL BLADE (25.0X0.89X90MM); BLADE, SAW, GENERAL & PLASTIC SURGERY,SURGICAL

Catalog Number	6125089090
Medical Device Problem Codes	Break (1069); Fracture (1260)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	09/24/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
A follow up report will be filed once the quality investigation is complete.Awaiting return of device to manufacturer.
Event or Problem Description
It was reported that during two separate surgical procedures, it was noted that the blade broke where it fits into the handpiece.It was also reported there were no adverse consequences as a result of this event.It was further reported that a minor delay occurred as a result of the event.It was also reported that the procedure was completed successfully.
Event or Problem Description
It was reported that during two separate surgical procedures, it was noted that the blade broke where it fits into the handpiece.It was also reported there were no adverse consequences as a result of this event.It was further reported that a minor delay occurred as a result of the event.It was also reported that the procedure was completed successfully.
Additional Manufacturer Narrative
Investigation results indicate that the blade coming into contact with cut guides/ surgical instruments could have caused the mount tab to fracture at the mount.The quality investigation is complete.

• Brand Name: PERFORMANCE SERIES SAGITTAL BLADE (25.0X0.89X90MM)
• Common Device Name: BLADE, SAW, GENERAL & PLASTIC SURGERY,SURGICAL
• Manufacturer (Section D): STRYKER INSTRUMENTS-KALAMAZOO; 4100 east milham avenue; kalamazoo MI 49001
• MDR Report Key: 9220420
• Report Number: 0001811755-2019-03282
• Device Sequence Number: 2184008
• Product Code: GFA
• UDI-Device Identifier: 04546540501479
• UDI-Public: 04546540501479
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• 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): 12/10/2019

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: 6125089090
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/29/2019
• Initial Date Received by Manufacturer: 09/25/2019
• Supplement Date Received by Manufacturer: 12/05/2019
• Initial Report FDA Received Date: 10/22/2019
• Supplement Report FDA Received Date: 12/10/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1