MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2018-08-21 for PKG, METZENBAUM SCISSORS, CURVED LONG 0250080265 manufactured by Stryker Endoscopy-san Jose.
[117778377]
Mfg date: the device manufacture date is not known at this time. However, should it become available it will be provided in future reports. Additional information will be provided once the investigation has been completed.
Patient Sequence No: 1, Text Type: N, H10
[117778378]
It was reported that a piece of the scissor fell off during a case. Additional information received states it was not known if the broken piece was retrieved from the patient.
Patient Sequence No: 1, Text Type: D, B5
[129639748]
The product was not returned for investigation therefore the reported failure mode was not confirmed. The reported failure mode will be monitored for future reoccurrence. Alleged failure: broken. Probable root cause: poor autoclave reliability. Shear pin failure in handle. Use error. The device manufacture date is not known.
Patient Sequence No: 1, Text Type: N, H10
[129639769]
It was reported that a piece of the scissor fell off during a case. Additional information received states it was not known if the broken piece was retrieved from the patient.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0002936485-2018-00586 |
| MDR Report Key | 7802398 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2018-08-21 |
| Date of Report | 2018-12-07 |
| Date of Event | 2018-07-25 |
| Date Mfgr Received | 2018-07-25 |
| Date Added to Maude | 2018-08-21 |
| 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 | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. CHESTER REBUGIO |
| 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 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PKG, METZENBAUM SCISSORS, CURVED LONG |
| Generic Name | ENDOSCOPIC GRASPING/CUTTING INSTRUMENT, NON-POWERED |
| Product Code | OCZ |
| Date Received | 2018-08-21 |
| Catalog Number | 0250080265 |
| Lot Number | 1644704 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| 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 | 2018-08-21 |