MAUDE Adverse Event Report: STRYKER ENDOSCOPY-SAN JOSE PKG, PRECISION AC 3-CHIP AUTOCLAVABLE CAMERA, C-MOUNT; LAPAROSCOPE, GENERAL & PLASTIC SURGERY

Model Number	0700410105
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	12/13/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Additional information will be provided once the investigation has been completed.
Event or Problem Description
It was reported that a camera head was getting hot.
Event or Problem Description
It was reported that a camera head was getting hot.
Additional Manufacturer Narrative
Alleged failure: ac precision cameras have been failing within 15 months of purchase.Image interference.The failure(s) identified in the investigation is consistent with the complaint record.Root cause: camera head conforms to specifications.Provable root cause of the issue could be the scope or the light cord.The product was returned for investigation and the failure mode will be monitored for future reoccurrence.

• Brand Name: PKG, PRECISION AC 3-CHIP AUTOCLAVABLE CAMERA, C-MOUNT
• Common Device Name: LAPAROSCOPE, GENERAL & PLASTIC SURGERY
• Manufacturer (Section D): STRYKER ENDOSCOPY-SAN JOSE; 5900 optical court; san jose CA 95138
• MDR Report Key: 9578297
• Report Number: 0002936485-2020-00022
• Device Sequence Number: 1877833
• Product Code: GCJ
• UDI-Device Identifier: 07613327137378
• UDI-Public: 07613327137378
• Combination Product (Y/N): N
• Initial Reporter State: IL
• Initial Reporter Country: US
• PMA/510(K) Number: K142603
• 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): 02/25/2020

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: Other
• Device Model Number: 0700410105
• Device Catalogue Number: 0700410105
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/18/2019
• Initial Date Received by Manufacturer: 12/13/2019
• Supplement Date Received by Manufacturer: 12/13/2019
• Initial Report FDA Received Date: 01/10/2020
• Supplement Report FDA Received Date: 02/26/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1