MAUDE MDR 3784201

MDR report key
3784201
Report number
8010047-2014-00181
Event key
0
Event type
3
Date of event
2014-04-01
Date received
2014-04-25
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
HIROKI MORIYAMA
Address
2951 ISHIKAWA-CHO HACHIOJI-SHI TOKYO 192-8 JA
Phone
264-264-2642
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1OLYMPUS RHINO-LARYNGOFIBERSCOPERHINO-LARYNGOFIBERSCOPEOLYMPUS MEDICAL SYSTEMS CORPORATIONCALENF-P4NAY Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-04-250

Event Narratives#

D

Patient 1

OLYMPUS MEDICAL SYSTEMS CORP. (OMSC) WAS INFORMED THAT DURING NASAL ENDOSCOPY, THE DOCTOR FELT THAT IT WAS DIFFICULT TO WITHDRAW THE SUBJECT DEVICE FROM THE PT, BUT THE DOCTOR REMOVED IT WITH STRONG FORCE AND CONSEQUENTLY, THE PT HAD A SLIGHT BLOODY NOSE TEMPORARILY. AFTER REMOVING IT FROM THE PT, THE DOCTOR FOUND THAT A METAL PART WAS EXPOSED DUE TO A SPLIT ON THE INSERTION TUBE.

N

Patient 1

BASED ON THE EVAL OF THE SUBJECT DEVICE BY OMSC, IT WAS CONFIRMED THAT THE INSERTION TUBE WAS SPLIT AND THERE WERE SCRATCHES AND INDENTATION MARKS NEAR THE SPLIT PART. BASED ON THE ABOVE RESULT, IT IS CONSIDERED THAT SINCE THE USER CONTINUED TO USE THE DEVICE WHILE THERE WERE SCRATCHES AND INDENTATION IN THE INSERTION TUBE, THE SCRATCHES AND INDENTATION GREW BIGGER AND IT FINALLY TORE THE INSERTION TUBE. IT IS POSSIBLE THAT THE SCRATCHES AND INDENTATION WERE CAUSED BY WITHDRAWING THE INSERTION TUBE FORCIBLY OR HITTING THE INSERTION TUBE WITH A HARD OBJECT. THE INSTRUCTION MANUAL OF ENF-P4 MENTIONS WARNING AND CAUTION FOR POSSIBLE MISHANDLING MENTIONED ABOVE. BASED ON THE FINDINGS, INAPPROPRIATE HANDLING BY THE USER COULD NOT BE RULED OUT AS A CONTRIBUTORY FACTOR OF THE EVENT. THIS REPORT IS BEING SUBMITTED AS A MEDICAL DEVICE REPORT IN AN ABUNDANCE OF CAUTION.