(b)(4): the customer reported during an ercp, the initial passage of the duodenoscope across the pylorus, in the prone position, was not feasible to due to the dilated stomach, body habitus and angulated/deformity at the junction of d1-d2.The endoscope was withdrawn and the patient was placed in the supine position.Subsequently, the scope was traversed to the second portion of the duodenum with some difficulty.The physician was using the endoscope with the distal cover.When the duodenoscope was withdrawn, the distal cover was not attached to the endoscope.According to the physician, nurse and endoscopy technicians, several attempts were made to retrieve the distal cover without success.Three (3) events reported by facility as follows: for event 1 of 3, see (b)(6).For event 2 of 3, see (b)(6).For event 3 of 3, see (b)(6).This is event 2 of 3 from the facility and includes 2 reports: (b)(6): maj-2315.H1y30 (b)(6): tjf-q190v, (b)(4).
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