PKG., SDC ULTRA 0240050988

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2010-02-05 for PKG., SDC ULTRA 0240050988 manufactured by Stryker Endoscopy San Jose.

Event Text Entries

[1334751] Incorrect data saved. If two patient are loaded in the to do list, when the images are saved, the incorrect patient data is being saved with the images. Example: patient one's pictures are getting patient 2's data.
Patient Sequence No: 1, Text Type: D, B5


[8441323] As part of a quality system improvement plan stryker corporation conducted a 2 year retrospective mdr review to ensure appropriate mdr reporting decisions. Events reported to stryker from 07/01/2006 to 07/01/2008 were the scope of this retrospective review. These events are being submitted under exemption (b)(4). There are 1 event(s) associated with this event type (malfunction) and product code lmb.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number2936485-2009-00437
MDR Report Key1621846
Report Source07
Date Received2010-02-05
Date of Report2010-02-05
Date of Event2007-11-14
Date Facility Aware2007-11-14
Date Mfgr Received2007-11-14
Date Added to Maude2010-10-15
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactNILA PATEL
Manufacturer Street5900 OPTICAL CT.
Manufacturer CitySAN JOSE CA 95138
Manufacturer CountryUS
Manufacturer Postal95138
Manufacturer Phone4087542000
Single Use3
Remedial ActionOT
Previous Use Code3
Removal Correction NumberNA
Event Type3
Type of Report3

Device Details

Brand NamePKG., SDC ULTRA
Generic NameINSTRUMENT
Product CodeLMD
Date Received2010-02-05
Returned To Mfg2007-12-06
Model NumberNA
Catalog Number0240050988
Lot NumberNI
ID NumberLMB
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerSTRYKER ENDOSCOPY SAN JOSE
Manufacturer AddressSAN JOSE CA 95138 US 95138


Patients

Patient NumberTreatmentOutcomeDate
10 2010-02-05

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