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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: OLYMPUS WINTER & IBE GMBH BERLIN FACILITY OLYMPUS ESG-100, 100...120 V~,

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OLYMPUS WINTER & IBE GMBH BERLIN FACILITY OLYMPUS ESG-100, 100...120 V~, Back to Search Results
Model Number WB991046
Medical Device Problem Codes Electrical /Electronic Property Problem (1198); Power Problem (3010)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 01/24/2026
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
The device was returned to olympus for inspection.A root cause could not be identified.Based on the results of the investigation, it is likely the following led to the malfunction: cause traced to component failure.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
It was observed that during the device evaluation, the olympus esg-100 encountered an e0246 error due to a component failure of the internal electronic board.There was no patient involvement.
 
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Brand Name
OLYMPUS ESG-100, 100...120 V~,
Common Device Name
OLYMPUS ESG-100, 100...120 V~,
Manufacturer (Section D)
OLYMPUS WINTER & IBE GMBH BERLIN FACILITY
rheinstrasse 8
teltow, brandenburg 14513
GM  14513
Manufacturer (Section G)
OLYMPUS WINTER & IBE GMBH BERLIN FACILITY
rheinstrasse 8
teltow, brandenburg 14513
GM   14513
Manufacturer Contact
todd brill
800 west park drive
westborough, MA 01581
5082077661
MDR Report Key24280804
Report Number3003724334-2026-00066
Device Sequence Number8318498
Product Code GEI
UDI-Device Identifier04042768910463
UDI-Public04042768910463
Combination Product (Y/N)N
Initial Reporter CountryJA
PMA/510(K) Number
N/A
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)N
Reporter Type Manufacturer
Report Source Foreign,Company Representative
Initial Reporter Occupation Non-Healthcare Professional
Type of Report Initial
Report Date (Section B) 02/06/2026
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 Other
Device Model NumberWB991046
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer10/01/2025
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 01/24/2026
Initial Report FDA Received Date02/06/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured09/16/2015
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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