MAUDE MDR 25303575

MDR report key
25303575
Report number
3020712480-2026-00027
Event key
0
Event type
3
Date of event
2026-05-07
Date received
2026-05-27
Adverse event
1
Product problem
1
Patients in event
0
Reporter occupation
2
Health professional
1
Initial report to FDA
0
Event location
0

Manufacturer Contact#

Contact
MR. JOHN TARTAL
Address
2225 NORTHWEST PARKWAY MARIETTA GA 30067 US
Phone
770-770-7709
Report source
M

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
236891ERBEFLO CLEVERCAP? HYBRID CO2 TUBING/CAP SETSCO2 TUBING/CAP SETSERBE MEDICAL. LLCFEQ20325-239W4466815NN
250582ERBEFLO CLEVERCAP? HYBRID CO2 TUBING/CAP SETSCO2 TUBING/CAP SETSERBE MEDICAL. LLCFEQ20325-239W4466815NN

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12026-05-270O

Event Narratives#

N

Patient 0

THE SET WAS NOT AVAILABLE FOR AN EVALUATION. NEVERTHELESS, WE HAVE RECEIVED SIMILAR REPORTS OF SETS LEAKING AT THE DISTAL END OF THE IRRIGATION LINE AND DOWN SCOPES. AT THIS TIME, TWO (2) PRIMARY CAUSES OF THE ISSUE HAVE BEEN DETERMINED: OFF-LABEL USE IN THAT ERBE MEDICAL LLC SETS ARE BEING USED WITH OTHER MANUFACTURERS PORT CONNECTORS (NOTE: PER THE NOTES ON USE FOR THE SET'S, ONLY ERBE ACCESSORIES (I.E., ERBE PORT CONNECTORS), ETC. ARE TO BE USED WITH ERBE TUBING/CAP SETS. A CHANGE HAD BEEN MADE TO THE SET'S CONNECTOR. CURRENTLY SETS ARE NOW BEING PRODUCED WITH THE PREVIOUS CONNECTOR TO MINIMIZE/ELIMINATE LEAKING. OTHER CONTRIBUTING CAUSES OF LEAKING AT THE END OF SCOPES ARE ALSO BEING INVESTIGATED. IF ANY PROMINENT CAUSES ARE DETERMINED AND/OR REMEDIES ARE IMPLEMENTED TO RESOLVE LEAKING, A FOLLOW-UP MDR WILL BE FILED.

D

Patient 0

IT WAS REPORTED THAT THE HYBRID CO2 TUBING/CAP SET FOR OLYMPUS? SCOPES & CO2 LEAKED FROM THE DISTAL END OF THE SCOPE DURING AN ESOPHAGOGASTRODUODENOSCOPY (EGD). THE SET WAS USED WITH A BOSTON SCIENTIFIC PORT CONNECTOR. DURING THE PROCEDURE, THE PATIENTS O2 LEVEL DROPPED; THEREFORE, THEY WERE INTUBATED. NO DETERMINATION COULD BE MADE AS TO THE CAUSE OF THE O2 LEVEL TO DROP. NEVERTHELESS, AT SOME POINT, THE PATIENT RECOVERED AND WAS DISCHARGED FROM THE HOSPITAL.