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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: GYRUS ACMI, INC. VIZISHOT 2 FLEX; SINGLE USE ASPIRATION NEEDLE

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GYRUS ACMI, INC. VIZISHOT 2 FLEX; SINGLE USE ASPIRATION NEEDLE Back to Search Results
Model Number NA-U403SX-4019
Medical Device Problem Code Difficult to Remove (1528)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 12/15/2025
Type of Reportable Event Malfunction
Event or Problem Description
It was reported the vizishot 2 flex with the first needle, the needle got stuck at the distal end of the sheath and could not be removed.The issue was found during a pulmonary examination ¿ lymph node staging, diagnostic.The intended procedure was completed with an olympus back-up device.There were no reports of patient injury or harm.
 
Additional Manufacturer Narrative
The investigation is ongoing.A supplemental report will be submitted when the investigation is completed or if additional information becomes available.
 
Additional Manufacturer Narrative
This report is being supplemented to provide additional information based on the approved final investigation.A review of the device history record found no deviations that could have caused or contributed to the reported issue.Based on the results of the investigation, and since the device was not returned for evaluation, the definitive root cause of the reported issue could not be determined.Should additional relevant information become available, a supplemental report will be submitted.Olympus will continue to monitor field performance for this device.
 
Event or Problem Description
No additional information received from customer.
 
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Brand Name
VIZISHOT 2 FLEX
Common Device Name
SINGLE USE ASPIRATION NEEDLE
Manufacturer (Section D)
GYRUS ACMI, INC.
9600 louisiana avenue north
brooklyn park MN 55445
Manufacturer (Section G)
GYRUS ACMI, INC.
9600 louisiana avenue north
brooklyn park MN 55445
Manufacturer Contact
todd brill
800 west park drive
westborough, MA 01581
5082077661
MDR Report Key23992954
Report Number3011050570-2026-00026
Device Sequence Number18772478
Product Code KTI
UDI-Device Identifier00821925043060
UDI-Public00821925043060
Combination Product (Y/N)N
Initial Reporter CountryAU
PMA/510(K) Number
K163469
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)N
Reporter Type Manufacturer
Report Source Foreign,User Facility
Initial Reporter Occupation Nurse
Type of Report Initial,Followup
Report Date (Section B) 03/17/2026
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 NumberNA-U403SX-4019
Was Device Available for Evaluation? Yes
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 12/16/2025
Supplement Date Received by Manufacturer02/18/2026
Initial Report FDA Received Date01/07/2026
Supplement Report FDA Received Date03/17/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured08/26/2025
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 Reuse
Patient Sequence Number1
Patient SexUnknown
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