FDA Adverse Event Malfunction Summary report: N

NA

MDR report key: 4914100 · Received July 14, 2015

Report

Report Number
0001056128-2015-00052
Event Type
Malfunction
Date Received
July 14, 2015
Date of Event
June 1, 2015
Report Date
June 12, 2015
Manufacturer
STRYKER SUSTAINABILITY SOLUTIONS LAKELAND
Product Code
NLQ
PMA / PMN Number
K133672
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NC, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

THE COMPLAINT DEVICE WAS RETURNED TO STRYKER SUSTAINABILITY SOLUTIONS FOR EVALUATION. INSPECTION OF THE RETURNED DEVICE REVEALED EVIDENCE OF CLINICAL USE INCLUDING BIOLOGICAL MATERIAL ON THE DISTAL TIP AND AN INDENTION IN THE TEFLON PAD. THE SHAFT ROTATION AND THE JAW ACTUATION OF THE DEVICE WERE FOUND TO BE ACCEPTABLE. THE DEVICE WAS CONNECTED TO A GENERATOR AND FAILED WITH TWO "TIGHTEN ASSEMBLY" ERRORS (AFTER WHICH THE ASSEMBLY WAS TIGHTENED) AND A "REPLACE INSTRUMENT" ERROR. THE DEVICE WAS EXAMINED FURTHER AND A BUILD UP OF TISSUE/FLUID WAS NOTICED ALONG THE ROD WHICH CAN DISRUPT HARMONIC FREQUENCY AND REDUCE CUTTING ABILITY. THE ROD WAS INSPECTED FOR FRACTURES, AND NONE WERE FOUND. THE DISTAL GASKET ON THE ROD WAS EXAMINED AND REVEALED SIGNS OF DAMAGE AND WEARING OF THE GASKET LIP WHICH WOULD ALLOW FLUID/TISSUE TO RISE UP THE ROD. THE CAUSE OF TISSUE/FLUID BUILD UP IS DAMAGE TO THE DISTAL GASKET; ACTION IS BEING TAKEN TO ADDRESS THIS ISSUE. TISSUE BUILD UP DUE TO DISTAL GASKET DAMAGE CAN DISRUPT HARMONIC FREQUENCY AND POTENTIALLY REDUCE CUTTING ABILITY; THEREFORE, THE REPORTED COMPLAINT WAS CONFIRMED.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE HAR36 ULTRASONIC SCALPEL WOULD NOT CAUTERIZE. THERE WAS NO MEDICAL INTERVENTION, SURGICAL DELAY, OR ADVERSE CONSEQUENCES REPORTED. THE PROCEDURE WAS COMPLETED SUCCESSFULLY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
454859 NA SCALPEL, ULTRASONIC, REPROCESSED NLQ STRYKER SUSTAINABILITY SOLUTIONS LAKELAND HAR36 3561347

Patients

Seq Age Sex Outcome Treatment
1