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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: OLYMPUS MEDICAL SYSTEMS CORP. ENDOSCOPE REPROCESSOR

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OLYMPUS MEDICAL SYSTEMS CORP. ENDOSCOPE REPROCESSOR Back to Search Results
Model Number OER-AW
Device Problem Mechanical Problem (1384)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Date 06/05/2020
Event Type  malfunction  
Manufacturer Narrative
The subject device has not been returned to olympus medical systems corp.(omsc) for evaluation.There were no further details provided.If significant additional information is received, this report will be supplemented.
 
Event Description
Olympus service operation repair center was informed from the facility that in unspecified timing there was a crack on the lid of the subject device.Other detailed information was not provided.There was no report of patient injury associated with the event.
 
Manufacturer Narrative
This supplemental report is being submitted to provide additional information.Olympus medical systems corp.(omsc) could not investigate the device because the device was not returned to omsc.Omsc reviewed the manufacturing history of the device and confirmed no irregularity.Omsc was surmised that the phenomenon occurred due to the following; the lid was cracked because of some strong impact.The instruction manual of the subject device states the corresponding method in case of an abnormality.
 
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Brand Name
ENDOSCOPE REPROCESSOR
Type of Device
ENDOSCOPE REPROCESSOR
Manufacturer (Section D)
OLYMPUS MEDICAL SYSTEMS CORP.
2951 ishikawa-cho
hachioji-shi, tokyo-to 192-8 507
JA  192-8507
MDR Report Key10228578
MDR Text Key222926460
Report Number8010047-2020-03863
Device Sequence Number1
Product Code FEB
Combination Product (y/n)N
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Type of Report Initial,Followup
Report Date 09/23/2020
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 No Information
Device Model NumberOER-AW
Was Device Available for Evaluation? No
Was the Report Sent to FDA? No
Initial Date Manufacturer Received 06/08/2020
Initial Date FDA Received07/03/2020
Supplement Dates Manufacturer Received08/24/2020
Supplement Dates FDA Received09/22/2020
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
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