MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 1998-04-27 for OLYMPUS A2637 83A2637 manufactured by Olympus Winter & Ibe Gmbh.
[7778717]
Upon eval, the mfr found that the epoxy cement used to secure an internal screw in the deflecting tip of the obturator had deteriorated over time. This allowed the screw to shift, and as a result, the obturator locked in a deflected position. To counter this phenomenon, the mfr has validated a change to a laser welding process.
Patient Sequence No: 1, Text Type: N, H10
[15035782]
The customer returned an a2637 obturator because it was frozen in position and would not angulate (device 1). Olympus contacted the customer to obtain add'l info regarding the device. Devices locked up during preparation before a medical procedure and was not used in the procedure.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9610773-1998-00009 |
| MDR Report Key | 165241 |
| Report Source | 05 |
| Date Received | 1998-04-27 |
| Date of Report | 1998-04-24 |
| Date Mfgr Received | 1998-03-20 |
| Date Added to Maude | 1998-05-01 |
| 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 | 0 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 0 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | OLYMPUS |
| Generic Name | OBTURATOR, 3 DEVICES |
| Product Code | FEC |
| Date Received | 1998-04-27 |
| Returned To Mfg | 1998-03-26 |
| Model Number | A2637 |
| Catalog Number | 83A2637 |
| Lot Number | 76W, 1 DEVICE |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 160830 |
| Manufacturer | OLYMPUS WINTER & IBE GMBH |
| Manufacturer Address | KUEHNSTRASSE 61 HAMBURG GM 22045 |
| Baseline Brand Name | OLYMPUS |
| Baseline Generic Name | OBTURATOR |
| Baseline Model No | A2637 |
| Baseline Catalog No | 83A2637 |
| Baseline ID | NA |
| Baseline Device Family | NA |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K931995 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 1998-04-27 |