MAUDE Adverse Event Report: AIZU OLYMPUS CO., LTD. GASTROINTESTINAL VIDEOSCOPE

Model Number GIF-XZ1200

Device Problem Insufficient Information (3190)

Patient Problem Drug Resistant Bacterial Infection (4553)

Event Type  Injury  

Manufacturer Narrative

The device referenced in this report was not returned to olympus for evaluation. The definitive cause of the user's experience cannot be determined at this time. The investigation is ongoing. This report will be updated upon completion of the investigation or upon receipt of additional relevant information.

Event Description

The customer reports there was an outbreak of extended spectrum beta-lactamase-resistant (esbl) bacteria at the hospital in patients who have undergone a procedure with a gastrointestinal videoscope (that had been reprocessed with an automatic scope reprocessor (aer)), per the physician in the infectious diseases department of the facility. The physician requested information regarding endoscope reprocessing methods and culture test methods in order to investigate the cause of the outbreak. It is unknown at this time if the outbreak is related to the scope. The field safety engineer (fse) staff has explained the culture method and reprocessing method to the facility. No scope culture results are available at this time. It is unknown how many patients are involved. It is unknown what treatment/intervention has been provided to the patients. The patients¿ current condition is unknown. This information has been requested and not yet provided. Case with patient identifier (b)(4) reports the scope case with patient identifier (b)(4) reports the automated scope reprocessor the scope has been reprocessed in.

• Brand Name: GASTROINTESTINAL VIDEOSCOPE
• Type of Device: GASTROINTESTINAL VIDEOSCOPE
• Manufacturer (Section D): AIZU OLYMPUS CO., LTD.; 3-1-1 niiderakita; aizuwakamatsu-shi, fukushima 965-8 520; JA 965-8520
• Manufacturer (Section G): AIZU OLYMPUS CO., LTD.; 3-1-1 niiderakita; aizuwakamatsu-shi, fukushima
• Manufacturer Contact: todd brill ; 800 west park drive; westborough, MA 01581 ; 5082077661
• MDR Report Key: 15998698
• MDR Text Key: 305683540
• Report Number: 9610595-2022-05602
• Device Sequence Number: 1
• Product Code: FDS
• Combination Product (y/n): N
• Reporter Country Code: JA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign,User Facility,Company Representative

Reporter Occupation

• Type of Report: Initial,Followup
• Report Date: 01/25/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/16/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes

Device Operator

• Device Model Number: GIF-XZ1200
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 01/16/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 06/17/2021
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse

Patient Treatment Data

Date Received: 12/16/2022 Patient Sequence Number: 1

Treatment

OER-5