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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: AIZU OLYMPUS CO., LTD. EVIS EXERA DUODENOVIDEOSCOPE

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AIZU OLYMPUS CO., LTD. EVIS EXERA DUODENOVIDEOSCOPE Back to Search Results
Model Number TJF-145
Medical Device Problem Code 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
It was reported that, during reprocessing, the duodenovideoscope tested positive for 1 colony forming units (cfus) of enteroccus hira.All channels were sampled.The user did not report any contamination or any other serious deterioration in state of health of any person, to which the scope could have been a contributory cause.
 
Additional Manufacturer Narrative
The investigation is ongoing.A supplemental report will be submitted when the investigation is completed or if additional information becomes available.
 
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Brand Name
EVIS EXERA DUODENOVIDEOSCOPE
Common Device Name
DUODENOVIDEOSCOPE
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 965-8 520
JA   965-8520
Manufacturer Contact
todd brill
800 west park drive
westborough, MA 01581
5082077661
MDR Report Key24274163
Report Number9610595-2026-12558
Device Sequence Number9948280
Product Code FDT
UDI-Device Identifier04953170339950
UDI-Public04953170339950
Combination Product (Y/N)N
Initial Reporter CountryBE
PMA/510(K) Number
K954451
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Y
Reporter Type Manufacturer
Report Source Foreign,Health Professional,User Facility
Initial Reporter Occupation Other Health Care Professional
Type of Report Initial,Followup
Report Date (Section B) 06/24/2026
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 NumberTJF-145
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 01/13/2026
Supplement Date Received by Manufacturer06/24/2026
Initial Report FDA Received Date02/05/2026
Supplement Report FDA Received Date06/24/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured08/07/2015
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 Number1
Patient SexUnknown
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