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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: KARL STORZ SE & CO. KG TELE PACK +

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KARL STORZ SE & CO. KG TELE PACK + Back to Search Results
Model Number TP101
Medical Device Problem Code Erratic or Intermittent Display (1182)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 01/07/2026
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
The device in question was returned to the manufacturer.This information is reflected in section d9.The evaluation is anticipated, but not yet begun.The investigation will be performed by a designated karl storz employee.The event is filed under internal karl storz complaint id: (b)(4).
 
Additional Manufacturer Narrative
The device in question was returned to the manufacturer.The evaluation is anticipated, but not yet begun.The investigation will be performed by a designated karl storz employee.The event is filed under internal karl storz complaint id: (b)(4).
 
Event or Problem Description
It was reported that "the image on the screen is flashing and cuts out".According to the information received, this happened during a veterinary procedure and the procedure could be completed with a prolongation of less than 15 minutes.There was no injury or impact to any human reported.No negative impact in state of health reported.The product concerned (tp101) is also intended for use during human medical procedures.
 
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Brand Name
TELE PACK +
Common Device Name
TELE PACK +
Manufacturer (Section D)
KARL STORZ SE & CO. KG
dr.-karl storz-strasse 34
tuttlingen, 78532
GM  78532
Manufacturer (Section G)
KARL STORZ SE & CO. KG
dr.-karl storz-strasse 34
tuttlingen, 78532
GM   78532
Manufacturer Contact
anja fair
2151 e grand ave
el segundo, CA 90245
MDR Report Key24321245
Report Number9610617-2026-00285
Device Sequence Number9475874
Product Code FET
UDI-Device Identifier04048551425701
UDI-Public04048551425701
Combination Product (Y/N)N
Initial Reporter CountryUK
PMA/510(K) Number
K221174
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source Foreign,Health Professional,User Facility,Company Representative
Initial Reporter Occupation Other Health Care Professional
Type of Report Initial,Followup
Report Date (Section B) 02/17/2026
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 NumberTP101
Device Catalogue NumberTP101
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer02/03/2026
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 01/20/2026
Supplement Date Received by Manufacturer02/03/2026
Initial Report FDA Received Date02/12/2026
Supplement Report FDA Received Date02/17/2026
Was Device Evaluated by Manufacturer? (Y/N) No
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 Unknown
Patient Sequence Number1
Patient SexUnknown
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