EVIS EXERA II ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,user f report with the FDA on 2018-04-26 for EVIS EXERA II ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F manufactured by Olympus Medical Systems Corp..

Event Text Entries

[107197063] The device was returned to olympus for evaluation on (b)(6) 2018. The evaluation confirmed the reported device issue. The distal end probe tip was found broken off. In addition, the probe insulation was found in critical condition. The scope was serviced and returned to the user facility. As part of our investigation, an olympus endoscopy support specialist (ess) was requested to be dispatched to the user facility to observe the facility? S reprocessing practice and to provide a reprocessing training. To date, the ess visit has not been completed. Based on the device evaluation results and similar reported events, the cause of the reported device issue could be attributed to improper maintenance of the device. The instruction manual states,? The probability of failure of the endoscope and ancillary equipment increases as the number of procedures performed and/or the total operating hours increase. In addition to the inspection before each procedure, the person in charge of medical equipment maintenance in each hospital should inspect the items specified in this manual periodically. An endoscope with an observed irregularity should not be used, but should be inspected by following section 10. 1,? Troubleshooting guide? On page 141. If the irregularity is still suspected after inspection, contact olympus.? This report will be supplemented if additional information becomes available.
Patient Sequence No: 1, Text Type: N, H10


[107197064] Olympus was informed that during an unspecified procedure, the tip of the scope broke off and fell inside the patient? S lung. It is unknown if the device fragment was retrieved from the patient. There was no patient injury reported.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2951238-2018-00277
MDR Report Key7465508
Report SourceCOMPANY REPRESENTATIVE,USER F
Date Received2018-04-26
Date of Report2018-06-20
Date of Event2018-04-06
Date Mfgr Received2018-04-26
Date Added to Maude2018-04-26
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. CONNIE TUBERA
Manufacturer Street2400 RINGWOOD AVENUE
Manufacturer CitySAN JOSE CA 95131
Manufacturer CountryUS
Manufacturer Postal95131
Manufacturer Phone408935-512
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameEVIS EXERA II ULTRASONIC BRONCHOFIBERVIDEOSCOPE
Generic NameULTRASONIC BRONCHOFIBERVIDEOSCOPE
Product CodePSV
Date Received2018-04-26
Returned To Mfg2018-04-06
Model NumberBF-UC180F
Catalog NumberBF-UC180F
Lot NumberN/A
ID Number#N/A
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerOLYMPUS MEDICAL SYSTEMS CORP.
Manufacturer Address2951 ISHIKAWA-CHO HACHIOJI-SHI, TOKYO-TO US


Patients

Patient NumberTreatmentOutcomeDate
10 2018-04-26

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