MAUDE Adverse Event Report: MAKO SURGICAL CORP. HIP END EFFECTOR, VARIABLE ANGLE; STEREOTAXIC DEVICE, ROBOTICS

Model Number	206967
Medical Device Problem Codes	Fracture (1260); Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	11/27/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
As part of the normal complaint follow-up, an evaluation of the event has been initiated by mako surgical.A supplemental report will be submitted when additional information becomes available.
Event or Problem Description
When breaking down the robot the back part of the end effector broke off and separated.Case type: tha.
Event or Problem Description
When breaking down the robot the back part of the end effector broke off and separated.Case type: tha.
Additional Manufacturer Narrative
Reported event: it was reported that when breaking down the robot the back part of the end effector broke off and separated.Product evaluation and results: product was not inspected as the product was not returned for evaluation.Product history review: 1.Review of the device history records indicate (b)(4) were manufactured and 9 accepted into final stock on 03/15/2017.Review of qt 17-03-0056 revealed that the 2 rejected devices were reinspected and accepted into stock on 08/21/2019.The non conformance is not related to the failure alleged.2.Review of the product history records indicate 4 devices were manufactured and all were accepted into final stock on 5/22/2017 with no reported discrepancies.Complaint history review: a review of complaints in catsweb and trackwise related to p/n 206967, lot number 19370816 shows 1 additional complaints related to the failure in this investigation.The complaint is (b)(4).Conclusions: the failure could not be determined as the product was not available for inspection.No additional investigation or specific actions are required.If additional information is received then the complaint will be reopened.Corrective action/preventive action: a review of stryker¿s nc/capa database indicated there have been an nc and capa associated with the product and failure mode reported in this event.This is nc 1414603 & capa 1450905.H3 other text : device not returned.

• Brand Name: HIP END EFFECTOR, VARIABLE ANGLE
• Common Device Name: STEREOTAXIC DEVICE, ROBOTICS
• Manufacturer (Section D): MAKO SURGICAL CORP.; 2555 davie road; fort lauderdale FL 33317
• MDR Report Key: 9512802
• Report Number: 3005985723-2019-00917
• Device Sequence Number: 13750476
• Product Code: OLO
• UDI-Device Identifier: 00848486022167
• UDI-Public: 00848486022167
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K121064
• 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
• Report Date (Section B): 02/19/2020

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: 206967
• Device Catalogue Number: 206967
• Device Lot Number: 19370816
• Was Device Available for Evaluation?: Yes
• Initial Date Received by Manufacturer: 11/27/2019
• Supplement Date Received by Manufacturer: 01/24/2020
• Initial Report FDA Received Date: 12/23/2019
• Supplement Report FDA Received Date: 02/19/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Age: 76 YR
• Patient Weight: 104