MAUDE MDR 1579940

MDR report key
1579940
Report number
8010047-2010-00007
Event key
0
Event type
3
Date received
2010-01-12
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
LAURA STORMS-TYLER
Address
2400 RINGWOOD AVE. SAN JOSE CA 95131 US
Phone
484-484-4848
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1OLYMPUS EVIS EXERA COLONOVIDEOSCOPECOLONOSCOPEOLYMPUS MEDICAL SYSTEMS CORPORATIONFTJCF-Q160LNANAY Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12010-01-120

Event Narratives#

D

Patient 1

THE USER FACILITY REPORTED TO HAVE IDENTIFIED A RECENT CLUSTER OF CLOSTRIDIUM DIFFICILE AMONG NINE PTS THAT HAD UNDERGONE ENDOSCOPY PROCEDURES. EIGHT OF THE PTS UNDERWENT COLONOSCOPIES, AND ONE PT UNDERWENT A GASTROSCOPY, BETWEEN DATES (B)(6)2009 AND (B)(6)2009. ONE OF THE COLONOSCOPY PTS WAS REPORTED TO HAVE BEEN HOSPITALIZED FOR AN UNSPECIFIED AMOUNT OF TIME. THE NINE AFFECTED PTS HAVE BEEN NOTIFIED AND ARE REPORTEDLY DOING FINE. NO FURTHER DETAILED INFO WAS PROVIDED BY THE USER FACILITY.

N

Patient 1

OLYMPUS FOLLOWED UP WITH THE USER FACILITY VIA PHONE AND IN WRITING TO OBTAIN ADDITIONAL DETAILED INFO REGARDING THE EVENT, HOWEVER ONLY LIMITED DETAILED INFO HAS BEEN RECEIVED TO DATE. AN OLYMPUS ENDOSCOPY SUPPORT SPECIALIST (ESS) VISITED THE USER FACILITY FOLLOWING THE REPORTED EVENT TO REVIEW AND PROVIDE IN-SERVICE TRAINING ON REPROCESSING PROCEDURES AS NEEDED. NO SIGNIFICANT REPROCESSING DEFICIENCIES WERE NOTED DURING THE ESS VISIT. THE COLONOSCOPE REFERENCED IN THIS REPORT WAS SENT TO AN INDEPENDENT LABORATORY FOR MICROBIOLOGICAL TESTING. WHILE FINAL TEST RESULTS HAVE NOT YET BEEN PROVIDED, THE DEVICE REFERENCED IN THIS REPORT TESTED POSITIVE FOR CLOSTRIDIUM PERFRINGENS AND ENTEROCOCCUS FAECALIS. THE DEVICE WAS FORWARDED TO OLYMPUS FOR EVAL FOLLOWING THE LABORATORY MICROBIOLOGICAL TESTING. THE EVAL FOUND SMALL AMOUNTS OF WHITE DEBRIS INSIDE THE CHANNEL MOUNT UNIT, SUCTION CYLINDER UNIT, AND THE INLET AND PROXIMAL ENDS OF THE AUXILLIARY WATER CHANNEL. THE DEVICE WILL BE SERVICED AND RETURNED TO THE CUSTOMER. OLYMPUS CONTINUES TO INVESTIGATE THIS REPORT. IF ANY SIGNIFICANT ADDITIONAL INFO BECOMES AVAILABLE, A SUPPLEMENTAL REPORT WILL BE PROVIDED. CROSS-REFERENCE MANUFACTURER REPORT NUMBERS 8010047-2010-00008 AND 8010047-2010-00009 FOR THE OTHER ASSOCIATED ENDOSCOPES. THIS REPORT IS BEING SUBMITTED AS A MEDICAL DEVICE REPORT IN AN ABUNDANCE OF CAUTION.