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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: SHIRAKAWA OLYMPUS CO., LTD. 4K UHD LCD MONITOR

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SHIRAKAWA OLYMPUS CO., LTD. 4K UHD LCD MONITOR Back to Search Results
Model Number OEV321UH
Device Problems No Display/Image (1183); Image Display Error/Artifact (1304)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 09/10/2023
Event Type  malfunction  
Manufacturer Narrative
The device was returned to olympus for evaluation.The image artifact was found to be due to poor contact of the liquid crystal display (lcd) panel.The investigation is ongoing, and a supplemental report will be submitted upon completion of the investigation or if any additional information is provided by the user facility.
 
Event Description
The customer reported to olympus that the monitor had vertical stripes.The issue was found during the middle of a diagnostic colonoscopy procedure that was completed with the same device without delay.The patient was sedated; however, there was no patient harm.The device was returned for evaluation.During the device evaluation, there was no image and green stripe on the display.This medical device report (mdr) is being submitted to capture the reportable malfunction found during evaluation.
 
Manufacturer Narrative
This report is being supplemented to provide additional information based on the legal manufacturer's final investigation.   a review of the device history record found no deviations that could have caused or contributed to the reported issue.It has been over 2 years since the subject device was manufactured.   based on the results of the investigation, a definitive root cause could not be determined.However, it is likely that the issue of the image issue occurred from a failure in the liquid crystal display panel.Olympus will continue to monitor field performance for this device. .
 
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Brand Name
4K UHD LCD MONITOR
Type of Device
MONITOR
Manufacturer (Section D)
SHIRAKAWA OLYMPUS CO., LTD.
3-1 okamiyama
odakura, nishigo-mura,
nishishirakawa-gun, fukushima 961-8 061
JA  961-8061
Manufacturer (Section G)
SHIRAKAWA OLYMPUS CO., LTD.
3-1 okamiyama
odakura, nishigo-mura,
nishishirakawa-gun, fukushima
Manufacturer Contact
todd brill
800 west park drive
westborough, MA 01581
5082077661
MDR Report Key18177228
MDR Text Key329022881
Report Number3002808148-2023-13127
Device Sequence Number1
Product Code GCJ
UDI-Device Identifier04953170418723
UDI-Public04953170418723
Combination Product (y/n)N
Reporter Country CodeSP
PMA/PMN Number
K220069
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Other,Foreign,Health Professional,User Facility,Company Representative
Reporter Occupation Other
Type of Report Initial,Followup
Report Date 01/16/2024
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 NumberOEV321UH
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer11/03/2023
Is the Reporter a Health Professional? No
Was the Report Sent to FDA? No
Initial Date Manufacturer Received 11/09/2023
Initial Date FDA Received11/20/2023
Supplement Dates Manufacturer Received01/04/2024
Supplement Dates FDA Received01/16/2024
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured08/26/2021
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Reuse
Patient Sequence Number1
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