MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2020-01-20 for LEFT IBO BLADE (10.0 X 0.38MM) 5100037902 manufactured by Stryker Instruments-kalamazoo.
[175712178]
A follow up report will be filed once the quality investigation is complete. Awaiting device return.
Patient Sequence No: 1, Text Type: N, H10
[175712179]
It was reported that the blade broke at the distal end during a procedure. No further information was provided.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 0001811755-2020-00098 |
| MDR Report Key | 9606736 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2020-01-20 |
| Date of Report | 2020-02-17 |
| Date of Event | 2019-12-27 |
| Date Mfgr Received | 2020-02-14 |
| Device Manufacturer Date | 2018-08-01 |
| Date Added to Maude | 2020-01-20 |
| 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 | RISK MANAGER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MRS. UNA BARRY |
| Manufacturer Street | INSTRUMENTS DIVISION CARRIGTWOHILL BUS. & TECH PARK |
| Manufacturer City | CARRIGTWOHILL NA |
| Manufacturer Country | IE |
| Manufacturer Postal | NA |
| Manufacturer Phone | 214532900 |
| Manufacturer G1 | STRYKER INSTRUMENTS-IRELAND |
| Manufacturer Street | INSTRUMENTS DIVISION CARRIGTWOHILL BUS. & TECH PARK |
| Manufacturer City | CARRIGTWOHILL NA |
| Manufacturer Country | IE |
| Manufacturer Postal Code | NA |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LEFT IBO BLADE (10.0 X 0.38MM) |
| Generic Name | BLADE, SAW, GENERAL & PLASTIC SURGERY,SURGICAL |
| Product Code | GFA |
| Date Received | 2020-01-20 |
| Model Number | 5100037902 |
| Catalog Number | 5100037902 |
| Lot Number | 18213017 |
| 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 INSTRUMENTS-KALAMAZOO |
| Manufacturer Address | 4100 EAST MILHAM AVENUE KALAMAZOO MI 49001 US 49001 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-01-20 |