MAUDE Adverse Event Report: AIZU OLYMPUS CO., LTD. SUCTION VALVE

Model Number	MD-493
Medical Device Problem Codes	Device Reprocessing Problem (1091); Microbial Contamination of Device (2303)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Event or Problem Description
The customer reported to olympus that the suction valves were contaminated with stenotrophomonas maltophilia bacteria.The issue occurred during reprocessing.There was no evidence of patient infection being detected but the suction valve contamination occurred due to inadequate reprocessing procedures followed onsite.There was no report of patient harm.The below 7 events for bacterial contamination are reported under the following patient identifiers: (b)(6), (b)(6), (b)(6), (b)(6), (b)(6), (b)(6), (b)(6).
Additional Manufacturer Narrative
The customer requested support regarding device reprocessing from olympus.The device will not be returned to olympus for evaluation.The investigation is ongoing and follow up with the user facility is currently being performed.A supplemental report will be submitted upon completion of the investigation or if any additional information is provided by the user facility.
Additional Manufacturer Narrative
This report is being supplemented to provide additional information based on the legal manufacturer's final investigation and a correction to h10.Please also see update to b5.Correction to h10, the following information was inadvertently left out of the initial report: contamination or culture results of the involved suction valves were not provided.Lot number of the valves were not provided as well.Additional information from the event reported: it was noted that the valves are autoclaved.The manufacturer's instructions on reprocessing for this and instructions on pre-cleaning was requested by the customer.In a follow up communication, the customer company representative clarified and confirmed that there was no patient infection.In addition, per the follow up report, the customer contacted the olympus representative ( application specialist) for support regarding reprocessing.As the customer has problems with reprocessing of the valves/endoscopes there are currently urgent assistance/clarifications on side of olympus to provide the instruction for use (ifu)s the customer requested and support the customer with the device portfolio.The device history record (dhr) was unable to be reviewed for this device however, olympus only releases products to market that meet all manufacturing specifications and final product release criteria.The reported event could not be confirmed because the subject device was not returned, an evaluation could not be preformed and the device could not be microbiologically tested by olympus.Based on the results of the investigation a root cause could not be conclusively identified.However, it is likely that how to reprocess md-493 (suction valve), instructed in instructions for use (ifu) of lf-series model device, was not familiarized enough at the user facility.The following ifu instructs reprocessing steps of md-493: - lf-gp/lf-tp: reprocessing manual 3.9 cleaning, disinfection and sterilization procedures for reusable parts and cleaning equipment.- ifu of lf-series model device warns on inappropriate reprocessing as follows: an insufficiently reprocessed endoscope and/or accessory may pose an infection control risk to the patients and/or operators who touch them.Olympus will continue to monitor field performance for this device.
Event or Problem Description
The following patient identifiers are related to this event: (b)(6), md-493: suction valve -1.(b)(6), md-493: suction valve -2.(b)(6), md-493: suction valve -3.(b)(6), md-493: suction valve -4.(b)(6), md-493: suction valve -5.(b)(6), md-493: suction valve -6.(b)(6), md-493: suction valve -7.(b)(6), lf-tp, sn (b)(6).(b)(6), lf-gp, sn (b)(6).(b)(6), lf-gp, sn (b)(6).(b)(6), lf-tp, sn (b)(6).(b)(6), lf-gp, sn (b)(6).

• Brand Name: SUCTION VALVE
• Common Device Name: SUCTION VALVE
• Manufacturer (Section D): AIZU OLYMPUS CO., LTD.; 3-1-1 niiderakita; aizuwakamatsu-shi, fukushima 965-8 520; JA 965-8520
• Manufacturer (Section G): AIZU OLYMPUS CO., LTD.; 3-1-1 niiderakita; aizuwakamatsu-shi, fukushima
• Manufacturer Contact: todd brill ; 800 west park drive; westborough, MA 01581 ; 5082077661
• MDR Report Key: 17379488
• Report Number: 9610595-2023-10498
• Device Sequence Number: 17717700
• Product Code: FDS
• UDI-Device Identifier: 04953170438196
• UDI-Public: 04953170438196
• Combination Product (Y/N): N
• Initial Reporter Country: GM
• PMA/510(K) Number: K002231
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,User Facility
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup
• Report Date (Section B): 09/21/2023

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: Health Professional
• Device Model Number: MD-493
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/26/2023
• Supplement Date Received by Manufacturer: 09/20/2023
• Initial Report FDA Received Date: 07/24/2023
• Supplement Report FDA Received Date: 09/21/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown