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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: OLYMPUS MEDICAL SYSTEMS CORP. URETERO-RENO FIBERSCOPE

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OLYMPUS MEDICAL SYSTEMS CORP. URETERO-RENO FIBERSCOPE Back to Search Results
Model Number URF-P7
Device Problem Break (1069)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Type  malfunction  
Event Description
Olympus medical systems corp.(omsc) was informed that during the incoming inspection for repair at the olympus local service department on may 25, 2021, it was found that the coating of the insertion tube of the subject device had been partially peeled off.Other detailed information was not provided.There was no report of patient injury associated with the event.This device is an olympus asset.
 
Manufacturer Narrative
The subject device was returned to the olympus local service department.A supplemental report will be submitted, if additional or significant information becomes available at a later time.
 
Manufacturer Narrative
This supplemental report is being submitted to provide additional information.Omsc was informed user information following.San joan hospital center s.I.E.Inst.Equipamentos portugal device history record review indicates that the product was manufactured and tested in accordance with all applicable procedures and met all final product release criteria.Olympus medical systems corp.(omsc) was informed that the insertion tube of the subject device was scratched.Omsc surmised that the reported phenomenon occurred due to physical stress and other on the insertion tube due to the user handling and other.
 
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Brand Name
URETERO-RENO FIBERSCOPE
Type of Device
URETERO-RENO FIBERSCOPE
Manufacturer (Section D)
OLYMPUS MEDICAL SYSTEMS CORP.
2951 ishikawa-cho
hachioji-shi, tokyo-to 192-8 507
JA  192-8507
Manufacturer Contact
kazutaka matsumoto
2951 ishikawa-cho
hachioji-shi, tokyo-to 192-8-507
JA   192-8507
426425177
MDR Report Key12914811
MDR Text Key285986902
Report Number8010047-2021-15391
Device Sequence Number1
Product Code FGB
Combination Product (y/n)N
Reporter Country CodeGM
PMA/PMN Number
K181451
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Foreign,Company Representative
Reporter Occupation Other
Type of Report Initial,Followup
Report Date 12/28/2021
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 Other
Device Model NumberURF-P7
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer05/25/2021
Is the Reporter a Health Professional? No
Was the Report Sent to FDA? No
Initial Date Manufacturer Received 05/25/2021
Initial Date FDA Received12/02/2021
Supplement Dates Manufacturer Received12/08/2021
Supplement Dates FDA Received12/28/2021
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured01/29/2018
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Unknown
Patient Sequence Number1
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