UNKNOWN

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a literature,user facility report with the FDA on 2018-12-27 for UNKNOWN manufactured by Olympus Medical Systems Corp..

Event Text Entries

[131620686] The subject devices have not been returned to omsc for evaluation. There was no malfunction report of the subject device associated to the reported patient outcomes. Since the serial numbers of these devices were not informed, omsc could not confirm the manufacturing history. The exact cause of the reported event could not be conclusively determined.
Patient Sequence No: 1, Text Type: N, H10


[131620687] On november 29, 2018, olympus medical systems corp. (omsc) received a literature titled? A study of procedure related endoscopic retrograde cholangiopancreatography (ercp) for postgastrectomy cases (roux-en-y reconstruction, billroth ii)?. The literature reported the study result on 90 cases of ercp procedures between november 2011 and july 2018 at the user facility for postgastrectomy cases having duodenal papilla. The literature reported that olympus endoscopes (pcf-q260ai, gif-q260, sif-h290s, pcf-pq260l, gif-q260j, pcf-q260azi, sif-q260, gif-2tq260m or jf-260v) or non-olympus endoscopes (en-450bi5, ei-580bt or en-450p) were used in the procedures. In the procedures, a transparent hood was attached to the distal end of the endoscopes other than using jf-260v. In the subject procedures, pancreatitis in 9 patients, cholangitis in 1 patient and perforation in 1 patient occurred. All cases of pancreatitis were mild and the symptoms were improved promptly with conservative medical treatment. The perforation was fixed by an emergency surgery. There was no information on which model of the endoscope was used in each procedure. Therefore, olympus is submitting mdr according to the number of the type of accidental symptom (pancreatitis, cholangitis and perforation). This is 3rd of 3 reports.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number8010047-2018-02588
MDR Report Key8201828
Report SourceLITERATURE,USER FACILITY
Date Received2018-12-27
Date of Report2019-03-03
Date Mfgr Received2019-02-13
Device Manufacturer Date2008-07-22
Date Added to Maude2018-12-27
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 Report3

Device Details

Brand NameUNKNOWN
Generic NameUNKNOWN
Product CodeGCQ
Date Received2018-12-27
Model NumberUNKNOWN
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerOLYMPUS MEDICAL SYSTEMS CORP.
Manufacturer Address2951 ISHIKAWA-CHO HACHIOJI-SHI, TOKYO-TO 192-8507 JA 192-8507


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2018-12-27

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