MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,distri report with the FDA on 2018-06-15 for GRASPING FORCEPS, 5 FR., SEMI-FLEXIBLE, STANDARD A2500 manufactured by Olympus Winter & Ibe Gmbh.
[111149128]
The suspect medical device has not yet been returned to olympus for evaluation/investigation. Therefore, the exact cause of the user's experience and the reported phenomenon could not be determined and is being judged as unknown. However, if the suspect medical device is returned for evaluation/investigation or additional significant information becomes available, this report will be updated.
Patient Sequence No: 1, Text Type: N, H10
[111149129]
Olympus was informed that during an unspecified procedure at an unknown date, the grasping forceps broke. It is unknown when exactly this damage occurred and whether a fragment fell inside the patient. No further information was provided, but the intended procedure was successfully completed with a similar device and there was no report about an adverse event or patient injury.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9610773-2018-00056 |
| MDR Report Key | 7604332 |
| Report Source | COMPANY REPRESENTATIVE,DISTRI |
| Date Received | 2018-06-15 |
| Date of Report | 2018-06-19 |
| Date Mfgr Received | 2018-06-18 |
| Device Manufacturer Date | 2017-03-01 |
| Date Added to Maude | 2018-06-15 |
| 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 | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. DANIEL WLADOW |
| Manufacturer Street | KUEHNSTRASSE 61 |
| Manufacturer City | HAMBURG 22045 |
| Manufacturer Country | GM |
| Manufacturer Postal | 22045 |
| Manufacturer Phone | 4940669662 |
| Manufacturer G1 | BACHER JOSEF GMBH |
| Manufacturer Street | EISENBAHNSTRASSE 19 |
| Manufacturer City | RIETHEIM-WEILHEIM |
| Manufacturer Country | US |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | GRASPING FORCEPS, 5 FR., SEMI-FLEXIBLE, STANDARD |
| Generic Name | HAND INSTRUMENTS, STANDARD (WITHOUT CURRENT) |
| Product Code | GCP |
| Date Received | 2018-06-15 |
| Returned To Mfg | 2018-06-07 |
| Model Number | A2500 |
| Catalog Number | A2500 |
| Lot Number | 173W |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | OLYMPUS WINTER & IBE GMBH |
| Manufacturer Address | KUEHNSTRASSE 61 HAMBURG US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-06-15 |