MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2013-12-10 for STRYKERVISION FLAT-PANEL MOUNTING ARM 0240095200 manufactured by Stryker Endoscopy-san Jose.
[3993622]
It was reported that the monitor fell out of the articulating arm on the stryker cart.
Patient Sequence No: 1, Text Type: D, B5
[11323503]
Additional information will be provided once the investigation has been completed.
Patient Sequence No: 1, Text Type: N, H10
[19395672]
The product was not returned for investigation. The reported failure mode could not be confirmed. Probable root causes for the reported failure could have been caused by: a missing or damaged fasteners/screws. However, this cannot be confirmed since the unit was not returned. In the event that the unit is returned, a full evaluation will be conducted and a follow up report will be issued. In sum, the product was not returned for investigation and the reported failure mode could not be confirmed. The failure mode will be monitored for future reoccurrence.
Patient Sequence No: 1, Text Type: N, H10
[19556439]
It was reported that the monitor fell out of the articulating arm on the stryker cart.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0002936485-2013-00570 |
| MDR Report Key | 3513589 |
| Report Source | 05 |
| Date Received | 2013-12-10 |
| Date of Report | 2013-11-15 |
| Date of Event | 2013-11-15 |
| Date Mfgr Received | 2013-11-15 |
| Date Added to Maude | 2014-03-24 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | BIOMEDICAL ENGINEER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | MR. THOMAS SHAFER |
| Manufacturer Street | 5900 OPTICAL COURT |
| Manufacturer City | SAN JOSE CA 95138 |
| Manufacturer Country | US |
| Manufacturer Postal | 95138 |
| Manufacturer Phone | 4087542000 |
| Manufacturer G1 | STRYKER ENDOSCOPY-SAN JOSE |
| Manufacturer Street | 5900 OPTICAL COURT |
| Manufacturer City | SAN JOSE CA 95138 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 95138 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | Z-2271-2013 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | STRYKERVISION FLAT-PANEL MOUNTING ARM |
| Generic Name | CART, EMERGENCY, CARDIOPULMONARY (EXCLUDING EQUIPMENT) |
| Product Code | BZN |
| Date Received | 2013-12-10 |
| Catalog Number | 0240095200 |
| Operator | OTHER |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | STRYKER ENDOSCOPY-SAN JOSE |
| Manufacturer Address | 5900 OPTICAL COURT SAN JOSE CA 95138 US 95138 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2013-12-10 |