MAUDE Adverse Event Report: INTUITIVE SURGICAL, INC. ION; BRONCHOSCOPE (FLEXIBLE OR RIGID)

Model Number	490206
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/16/2022
Type of Reportable Event	Malfunction
Event or Problem Description
The rep could not get the vision probe to function for the procedure, attempted multiple times.

• Brand Name: ION
• Common Device Name: BRONCHOSCOPE (FLEXIBLE OR RIGID)
• Manufacturer (Section D): INTUITIVE SURGICAL, INC.; 1266 kifer road; sunnyvale CA 94086
• MDR Report Key: 16303134
• Report Number: 16303134
• Device Sequence Number: 17843225
• Product Code: EOQ
• UDI-Device Identifier: 00886874121184
• UDI-Public: 00886874121184
• Combination Product (Y/N): N
• Initial Reporter State: TN
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: User Facility
• Initial Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date (Section B): 01/24/2023
• Report Date (Section F): 01/24/2023

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
• Operator of Device: Other
• Device Model Number: 490206
• Device Lot Number: 511220725
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: Yes
• Event Location: Hospital
• Date Report to Manufacturer: 02/06/2023
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 02/06/2023
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Unknown
• Date Report Sent to FDA: 01/24/2023