MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2015-02-10 for SYSTEM 5 DUAL TRIGGER ROTARY HANDPIECE 4205000000 manufactured by Stryker Instruments-kalamazoo.
[5332520]
It was reported during service at manufacturer facility that a pin is missing from the front plate of the handpiece. This event occurred during repair therefore there is no associated procedure, no patient involvement, no delay, no medical intervention and no adverse consequences.
Patient Sequence No: 1, Text Type: D, B5
[5525349]
It was reported during service at manufacturer facility that a pin is missing from the front plate of the handpiece. This event occurred during repair therefore there is no associated procedure, no patient involvement, no delay, no medical intervention and no adverse consequences.
Patient Sequence No: 1, Text Type: D, B5
[12840572]
The device has been received, failure analysis is in progress; additional information will be submitted once the quality investigation is completed. Failure analysis is on progress.
Patient Sequence No: 1, Text Type: N, H10
[12961930]
The reported event, straight pin is missing, was confirmed. Device was repaired and returned to the customer after passing the final inspection.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 0001811755-2015-00433 |
| MDR Report Key | 4502176 |
| Report Source | 07 |
| Date Received | 2015-02-10 |
| Date of Report | 2015-01-13 |
| Date of Event | 2015-01-13 |
| Date Mfgr Received | 2015-02-19 |
| Device Manufacturer Date | 2006-04-17 |
| Date Added to Maude | 2015-02-10 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | MR. CASEY METZGER |
| Manufacturer Street | 4100 EAST MILHAM AVENUE |
| Manufacturer City | KALAMAZOO MI 49001 |
| Manufacturer Country | US |
| Manufacturer Postal | 49001 |
| Manufacturer Phone | 2693237700 |
| Manufacturer G1 | STRYKER INSTRUMENTS-KALAMAZOO |
| Manufacturer Street | 4100 EAST MILHAM AVENUE |
| Manufacturer City | KALAMAZOO MI 49001 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 49001 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SYSTEM 5 DUAL TRIGGER ROTARY HANDPIECE |
| Generic Name | INSTRUMENT, SURGICAL, ORTHOPEDIC, DC-POWERED MOTOR AND ACCESSORY/ATTACHMENT |
| Product Code | KIJ |
| Date Received | 2015-02-10 |
| Returned To Mfg | 2014-12-22 |
| Catalog Number | 4205000000 |
| Operator | OTHER |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | STRYKER INSTRUMENTS-KALAMAZOO |
| Manufacturer Address | 4100 EAST MILHAM AVENUE KALAMAZOO MI 49001 US 49001 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2015-02-10 |