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 with the FDA on 2018-06-11 for EVIS EXERA II ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F manufactured by Olympus Medical Systems Corp..

Event Text Entries

[111020400] The subject device has not been returned to omsc for evaluation. The exact cause could not be determined at present. If significant additional information is received, this report will be supplemented.
Patient Sequence No: 1, Text Type: N, H10


[111020401] Olympus medical systems corp. (omsc) was informed that during a unspecified bronchoscope procedure, the user facility noticed that a unspecified tube stuck within the instrument channel of the subject device when inserting a non-olympus biopsy needle (endo flex nebs41 221-c) into the channel. The facility reported that no obstruction was observed in the channel during the cleaning right before the procedure. Other detailed information was not provided from the user facility but there was no report of patient injury associated with this event.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number8010047-2018-01117
MDR Report Key7590023
Date Received2018-06-11
Date of Report2018-07-26
Date Mfgr Received2018-06-28
Date Added to Maude2018-06-11
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 ContactMR KAZUTAKA MATSUMOTO
Manufacturer Street2951 ISHIKAWA-CHO
Manufacturer CityHACHIOJI-SHI, TOKYO-TO 192-8507
Manufacturer CountryJA
Manufacturer Postal192-8507
Manufacturer Phone426425177
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameEVIS EXERA II ULTRASONIC BRONCHOFIBERVIDEOSCOPE
Generic NameULTRASONIC BRONCHOFIBERVIDEOSCOPE
Product CodePSV
Date Received2018-06-11
Returned To Mfg2018-05-30
Model NumberBF-UC180F
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerOLYMPUS MEDICAL SYSTEMS CORP.
Manufacturer Address2951 ISHIKAWA-CHO HACHIOJI-SHI, TOKYO-TO US


Patients

Patient NumberTreatmentOutcomeDate
10 2018-06-11

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