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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: OLYMPUS MEDICAL SYSTEMS CORP. SINGLE USE MECHANICAL LITHOTRIPTOR V

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OLYMPUS MEDICAL SYSTEMS CORP. SINGLE USE MECHANICAL LITHOTRIPTOR V Back to Search Results
Model Number BML-V442QR-30
Device Problem Difficult to Open or Close (2921)
Patient Problem Patient Problem/Medical Problem (2688)
Event Date 09/11/2020
Event Type  malfunction  
Manufacturer Narrative
The device was returned to olympus for evaluation.The evaluation has not been completed; therefore, the user¿s complaint has not been confirmed.We are unable to determine a root cause for the reported event.If additional information becomes available following the device evaluation, a supplemental report will be filed.
 
Event Description
The user facility reported that there was an issue with the device.During a therapeutic endoscopic retrograde cholangiopancreatography (ercp) procedure, the user assembled the basket and the handle according to the instructions.When the physician wanted to capture the first gall stone, he took out the basket in the common bile duct and captured a first stone of about 1cm.He wanted to close the basket to crush the stone.The basket did not appear to close as usual and he was unable to crush the stone.He took the basket out of the common bile duct and the stone was released into the duodenum.It was impossible to put the basket in the sheath to return to the common bile duct.The mechanism no longer worked.He decided to put a plastic stent in the bile duct and go back in a few weeks to try and capture the bigger stone which must be around 20mm.The patient was agitated, and the physician did not want to take the time to take out another basket to continue, so he decided to stop.Nothing has happened to the patient; she is in good health and the procedure will be resumed later.There was no patient injury or harm.No additional information was provided.
 
Manufacturer Narrative
This supplemental report is being submitted to provide the additional information from the legal manufacturer regarding the final investigation.The legal manufacturer (lm) reviewed the content of this complaint for further investigation.The device history record for the lot indicated no anomaly with the event-related items below.The legal manufacturer reported that the root cause could not be determined.The lm reported that the most probable causes for the reported event are as follows: based on the similar investigation results in the past, a likely mechanism causing the reported event might be the following.1)due to various factors such as the shape, numbers, hardness of the calculus, and the magnitude of the force necessary to close the basket, it can be inferred that a force larger than expected might have been applied to the device while the basket was grasping the calculus.2)due to in state of ¿1¿ description, the basket became incarcerated.3)an attempt was forcefully made to retract the basket by pulling the operation pipe, causing the joint between the operation pipe and the wire to break.4)the basket could not be moved because the operation pipe broke.The legal manufacturer reported that the instruction manual provides the statements below.Never use excessive force to operate the instrument and bml handle.This could damage the instrument and/or bml handle.Make sure the screw is tightened.If not securely tightened, the pipe may detach, the basket may not to be moved, and/or the calculus may not be crushed.Make sure to have the stopper and the bml handle connected.If the instrument separates from the bml handle during operation, the pipe may break or become uncontrollable.Also, this instrument with calculus engaged may not be removed from the body.When the lithotriptor¿s basket does not smoothly open or close, do not apply force but move the forceps elevator or the scope¿s angle back, or move the position of the basket until the basket opens or closes with ease.If the action is forced, the tube may stretch and cannot be stored inside the coil sheath.Also, the calculus may not be crushed, and/or the instrument with calculus engaged may not be removed from the body.This instrument will deform and/or deteriorate by performing lithotripsy.When lithotripsy is repeated, it will deform and/or deteriorate furthermore.By such deformation and/or deterioration, calculus may not be crushed and/or the instrument with calculus engaged may not be removed from the body.If lithotripsy is required to be repeated in a single case, make sure to check each time that no abnormality is found in action and/or appearance (e.G.Basket wire cut or worn, tube sheath bent, notable coil sheath bent or gap etc.).Stop use when any abnormality is detected.During lithotripsy, keep the portion from the coil sheath to the bml handle straight in line with the scope¿s biopsy valve, as much as possible.If not straight, the coil sheath may bend, calculus may not be crushed, and/or the instrument with calculus engaged may not be removed from the body.
 
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Brand Name
SINGLE USE MECHANICAL LITHOTRIPTOR V
Type of Device
SINGLE USE MECHANICAL LITHOTRIPTOR
Manufacturer (Section D)
OLYMPUS MEDICAL SYSTEMS CORP.
2951 ishikawa-cho
hachioji-shi, tokyo-to 192-8 507
JA  192-8507
MDR Report Key10673354
MDR Text Key224636144
Report Number8010047-2020-07631
Device Sequence Number1
Product Code LQC
UDI-Device Identifier04953170218422
UDI-Public04953170218422
Combination Product (y/n)N
PMA/PMN Number
CLASS2-EXMPT
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Type of Report Initial,Followup
Report Date 01/10/2021
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Model NumberBML-V442QR-30
Device Lot Number7ZK
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer10/05/2020
Was the Report Sent to FDA? No
Initial Date Manufacturer Received 09/14/2020
Initial Date FDA Received10/13/2020
Supplement Dates Manufacturer Received12/03/2020
Supplement Dates FDA Received01/10/2021
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
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