MAUDE Adverse Event Report: AIZU OLYMPUS CO., LTD. BRONCHOVIDEOSCOPE

Model Number	BF-P150
Medical Device Problem Code	No Display/Image (1183)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/19/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
E1 to be continued: (b)(6) university.The device evaluation is ongoing.Should additional relevant information become available, a supplemental report will be submitted.
Event or Problem Description
It was reported, the flex video scope screen black out with noise during angulation.There were no reports of patient harm.
Event or Problem Description
The event was diagnostic procedure, that was completed without delay using the same device, no patient was under anesthesia.
Additional Manufacturer Narrative
This supplemental report is being submitted to provide the correction of the initial mdr and the legal manufacturer's final investigation.Corrected fields: b5, e2 (must remain blank), e3 (must remain blank) and g2 (remove health care professional).Additional information: d10 and h6.A review of the device history record and historical complaints analysis was conducted and no deviations that could have caused or contributed to the reported issue was identified.A definitive root cause was not identified, however based on the results of the investigation, the probable cause of the "no image with noise during angulation " malfunctions would likely be related to charged coupled device cable that was pressed and was about to break.The event can be prevented by following the instructions for use which state: important information ¿ please read before use warnings and cautions: caution ·do not touch the electrical contacts inside the electrical connector.Ccd damage may result.·turn the video system center cv-150 off before connecting or disconnecting the videoscope cable from the electrical connector on the endoscope.Turn the video system center cv-150 on or off only when the videoscope cable is connected to both the video system center cv-150 and the electrical connector on the endoscope.Failure to do so can result in equipment damage, including destruction of the ccd.3.6 inspection of the endoscopic system inspection of the endoscopic image 4.While observing the palm of your hand, confirm that the endoscopic image is free from noise, blur, fog or other irregularities.5.Angulate the endoscope and confirm that the endoscopic image does not momentarily disappear or displays any other irregularities.Chapter 5 troubleshooting if the endoscope is visibly damaged, does not function as expected or is found to have irregularities during the inspection described in chapter 3, ¿preparation and inspection¿, do not use the endoscope.Contact olympus.Some problems that appear to be malfunctions may be correctable by referring to section 5.1, ¿troubleshooting guide¿ on page 55.If the problem cannot be resolved by the described remedial action, stop using the endoscope and send it to olympus for repair.If any abnormality in the function of the endoscope and/or endoscopic image is suspected during use, stop the examination immediately and carefully withdraw the endoscope from the patient as described in section 5.2, ¿withdrawal of the endoscope with an abnormality¿ on page 58.Olympus will continue to monitor field performance for this device.

• Brand Name: BRONCHOVIDEOSCOPE
• Common Device Name: BRONCHOVIDEOSCOPE
• 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: 19479681
• Report Number: 9610595-2024-11432
• Device Sequence Number: 15186550
• Product Code: EOQ
• UDI-Device Identifier: 04953170308178
• UDI-Public: 04953170308178
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K023984
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,Health Professional,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/14/2024

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: BF-P150
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/23/2024
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: 06/12/2024
• Initial Report FDA Received Date: 06/06/2024
• Supplement Report FDA Received Date: 06/14/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 11/01/2013
• 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
• Concomitant Medical Products and Therapy/Usage Dates: CV-150-VIDEO SYSTEM CENTER
• Patient Sex: Unknown