MAUDE Adverse Event Report: STRYKER INSTRUMENTS-KALAMAZOO 4.0MM ROUND SOLID CARBIDE BUR LONG; BUR, SURGICAL, GENERAL & PLASTIC SURGERY

Model Number	5300020511
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	11/21/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
A follow up report will be filed once the quality investigation is complete.Awaiting device return.
Event or Problem Description
It was reported that prior to a surgical procedure, while testing, the bur broke.It was also reported that this event did not occur during a surgical procedure and there was no delay or adverse consequences as a result of this event.
Additional Manufacturer Narrative
H6: the definitive root cause could not be determined.A photograph of the broken device was provided which confirmed the breakage.The quality investigation is complete.
Event or Problem Description
It was reported that prior to a surgical procedure, while testing, the bur broke.It was also reported that this event did not occur during a surgical procedure and there was no delay or adverse consequences as a result of this event.
Additional Manufacturer Narrative
The quality investigation is complete.
Event or Problem Description
It was reported that prior to a surgical procedure, while testing, the bur broke.It was also reported that this event did not occur during a surgical procedure and there was no delay or adverse consequences as a result of this event.

• Brand Name: 4.0MM ROUND SOLID CARBIDE BUR LONG
• Common Device Name: BUR, SURGICAL, GENERAL & PLASTIC SURGERY
• Manufacturer (Section D): STRYKER INSTRUMENTS-KALAMAZOO; 4100 east milham avenue; kalamazoo MI 49001
• MDR Report Key: 9495209
• Report Number: 0001811755-2019-04094
• Device Sequence Number: 2079280
• Product Code: GFF
• UDI-Device Identifier: 07613153000983
• UDI-Public: 07613153000983
• Combination Product (Y/N): N
• Initial Reporter State: IL
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 03/12/2020

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 Expiration Date: 08/01/2024
• Device Model Number: 5300020511
• Device Catalogue Number: 5300020511
• Device Lot Number: 19226017
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/25/2020
• Initial Date Received by Manufacturer: 11/21/2019
• Supplement Date Received by Manufacturer: 02/11/2020; 02/25/2020
• Initial Report FDA Received Date: 12/19/2019
• Supplement Report FDA Received Date: 02/11/2020; 03/12/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1