FDA Adverse Event Malfunction Summary report: N

PRECISION IDEAL EYES 5.5MM 30°, HD AUTOCLAVABLE LAPAROSCOPE 30CM

MDR report key: 15989080 · Received December 15, 2022

Report

Report Number
0002936485-2022-00759
Event Type
Malfunction
Date Received
December 15, 2022
Date of Event
December 1, 2022
Report Date
February 3, 2023
Manufacturer
STRYKER ENDOSCOPY-SAN JOSE
Product Code
GCJ
UDI-DI
07613327059144
PMA / PMN Number
K910132
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
DA
Reporter Occupation
NURSE
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

ALLEGED FAILURE: "KUNDE RAPPORTERER AT SCOPE ER SLØRET LÆGGER OPTIK TIL VI KAN KOMME FORBI OG TJEKKE. OPTIK SKØNNES VED SYN AT VÆRE SLØRET TRODS RENS MED POLISH PASTA OG GENEREL RENGØRING" "CUSTOMER REPORTS SCOPE IS BLURRY LAYING OPTICS UNTIL WE CAN COME BY AND CHECK. OPTICS ARE ESTIMATED TO BE BLURRY DESPITE CLEANING WITH POLISH PASTE AND GENERAL CLEANING" THE FAILURE ALLEGED IN THE COMPLAINT RECORD WAS NOT CONFIRMED/DUPLICATED DURING THE PRODUCT INVESTIGATION. THE PROBABLE ROOT CAUSES COULD BE ROUGH HANDLING DURING STERILIZATION AND/OR PRODUCT TRANSPORT. THE PRODUCT WAS RETURNED FOR INVESTIGATION AND THE FAILURE MODE WILL BE MONITORED FOR FUTURE REOCCURRENCE. MANUFACTURE DATE IS NOT KNOWN.

Additional Manufacturer Narrative · 0

ADDITIONAL INFORMATION WILL BE PROVIDED ONCE THE INVESTIGATION HAS BEEN COMPLETED. THE DEVICE MANUFACTURER DATE IS NOT KNOWN AT THIS TIME. HOWEVER, SHOULD IT BECOME AVAILABLE IT WILL BE PROVIDED IN FUTURE REPORTS.

Description of Event or Problem · 0

IT WAS REPORTED THAT THERE WAS BLURRY IMAGE.

Description of Event or Problem · 0

IT WAS REPORTED THAT THERE WAS BLURRY IMAGE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2777913 PRECISION IDEAL EYES 5.5MM 30°, HD AUTOCLAVABLE LAPAROSCOPE 30CM LAPAROSCOPE, GENERAL & PLASTIC SURGERY GCJ STRYKER ENDOSCOPY-SAN JOSE 0502503030 07613327059144

Patients

Seq Age Sex Outcome Treatment
1 Unknown