MAUDE Adverse Event Report: CUSTOM ULTRASONICS INC. SYSTEM 83 PLUS; ENDOSCOPE WASHER DISINFECTOR

Model Number SYSTEM 83 PLUS 2/9

Device Problem Device Inoperable (1663)

Patient Problem No Information (3190)

Event Date 09/13/2016

Event Type  malfunction  

Manufacturer Narrative

There are no patient injuries associated with this event.The reported symptom was attributed to an open diode, on the ac input signal, within the bridge rectifier, brg1, on the ultrasonic generator (500 w) board, p/n 12008, causing the fuse to open, rendering the board inoperable.This diode is located on the ac input (+) side of the bridge rectifier and its failure is likely attributed to an over voltage or over current condition.The loss of the ultrasonic generator performance does not, of and by itself, result in an endoscopic high level disinfection process failure.Its failure does not render a microbiologically unsafe product or present any additional risks for reuse given the nature of the pre-cleaning labeling instructions and high-level disinfection.Given the nature of endoscope pre-processing and high-level disinfection, either the presence or absence of ultrasonics should still result is an endoscope that has had its bioburden reduced to an acceptable level.It is concluded that there is no reasonable likelihood that an endoscope processed in the absence of the ultrasound will present any additional risks.

Event Description

The facility's biomed technician noticed that the ultrasonic function was not working.

• Brand Name: SYSTEM 83 PLUS
• Type of Device: ENDOSCOPE WASHER DISINFECTOR
• Manufacturer (Section D): CUSTOM ULTRASONICS INC.; 144 railroad drive; ivyland PA 18974
• Manufacturer Contact: elizabeth lazaro ; 144 railroad drive; ivyland, PA 18974 ; 2153641477
• MDR Report Key: 5998122
• MDR Text Key: 57086054
• Report Number: 3007082252-2016-00038
• Device Sequence Number: 1
• Product Code: FEB
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K983017
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Reporter Occupation: Biomedical Engineer
• Type of Report: Initial
• Report Date: 09/13/2016

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 Number: SYSTEM 83 PLUS 2/9
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 09/13/2016
• Initial Date FDA Received: 10/04/2016
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 11/16/2002
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1