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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: OLYMPUS WINTER & IBE GMBH RESECTION SHEATH, 24 FR.; GYNECOLOGY HYSTEROSCOPE
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OLYMPUS WINTER & IBE GMBH RESECTION SHEATH, 24 FR.; GYNECOLOGY HYSTEROSCOPE Back to Search Results
Model Number A22041A
Device Problem Loose or Intermittent Connection (1371)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 03/31/2024
Event Type  malfunction  
Event Description
It was observed during the device inspection, that the gynecology hysteroscope exhibited a loose ceramic tip.There were no reports of patient involvement.
 
Manufacturer Narrative
The device evaluation is ongoing.Should additional relevant information become available, a supplemental report will be submitted.
 
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Brand Name
RESECTION SHEATH, 24 FR.
Type of Device
GYNECOLOGY HYSTEROSCOPE
Manufacturer (Section D)
OLYMPUS WINTER & IBE GMBH
kuehnstrasse 61
hamburg, hamburg 22045
GM  22045
Manufacturer (Section G)
OLYMPUS WINTER & IBE GMBH
kuehnstrasse 61
hamburg, hamburg 22045
GM   22045
Manufacturer Contact
todd brill
800 west park drive
westborough, MA 01581
5082077661
MDR Report Key19145270
MDR Text Key340978638
Report Number9610773-2024-01059
Device Sequence Number1
Product Code HIH
UDI-Device Identifier04042761020961
UDI-Public04042761020961
Combination Product (y/n)N
Reporter Country CodeCH
PMA/PMN Number
K931995
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Other,Foreign,Company Representative
Reporter Occupation Other
Type of Report Initial
Report Date 04/19/2024
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received04/19/2024
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Other
Device Model NumberA22041A
Device Lot Number15ZW-0008
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer04/11/2024
Was the Report Sent to FDA? No
Date Manufacturer Received04/19/2024
Was Device Evaluated by Manufacturer? No
Date Device Manufactured12/01/2015
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Reuse
Patient Sequence Number1
Treatment
VISERA ELITE VIDEO SYSTEM CENTER.
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