| Brand Name | THUNDERBEAT 5 MM, 20 CM, FRONT-ACTUATED GRIP TYPE S |
| Common Device Name | ULTRASONIC SURGICAL DEVICE |
| Manufacturer (Section D) |
| AOMORI OLYMPUS CO., LTD. |
| 2-248-1 okkonoki |
| kuroishi-shi, aomori 036-0 357 |
| JA 036-0357 |
|
| Manufacturer (Section G) |
| AOMORI OLYMPUS CO., LTD. |
| 2-248-1 okkonoki |
|
| kuroishi-shi, aomori 036-0 357 |
|
JA
036-0357
|
|
| Manufacturer Contact |
|
todd
brill
|
| 800 west park drive |
| westborough, MA 01581
|
|
5082077661
|
|
| MDR Report Key | 23745772 |
| Report Number | 9614641-2025-02022 |
| Device Sequence Number | 16004633 |
| Product Code |
GEI
|
| UDI-Device Identifier | 04953170383588 |
| UDI-Public | 04953170383588 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | GM |
| PMA/510(K) Number | K211838 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | Unknown |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Health Professional,User Facility |
| Initial Reporter Occupation |
Nurse
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
05/20/2026 |
| 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 | TB-0520FCS |
| Device Lot Number | UNKNOWN |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Initial |
| Initial Date Received by Manufacturer | 11/17/2025 |
| Supplement Date Received by Manufacturer | 04/30/2026
|
| Initial Report FDA Received Date | 12/08/2025 |
| Supplement Report FDA Received Date | 05/20/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|