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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ERBE MEDICAL. LLC ERBEFLO CLEVERCAP® HYBRID CO2 TUBING/CAP SETS

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ERBE MEDICAL. LLC ERBEFLO CLEVERCAP® HYBRID CO2 TUBING/CAP SETS Back to Search Results
Catalog Number 20325-240
Medical Device Problem Code Leak/Splash (1354)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 01/29/2026
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Sets were returned to the manufacturer for analysis.Per manufacturer, the reported issue has been evaluated and determined to be associated with a broader trend involving unprompted flow associated with connector interactions.Specifically, we received similar reports of sets leaking at the distal end of the irrigation line and down scopes.At this time, two (2) primary causes of the issue have been determined: 1.Off-label use in that erbe medical llc sets are being used with other manufacturers port connectors (note: per the notes on use for the set's, only erbe accessories (i.E., erbe port connectors), etc.Are to be used with erbe tubing/cap sets.2.A change had been made to the set's connector.Currently sets are now being produced with the previous connector to minimize/eliminate leaking.Other contributing causes of leaking at the end of scopes are also being investigated.If any prominent causes are determined and/or remedies are implemented to resolve leaking, a follow-up mdr will be filed.
 
Event or Problem Description
It was reported that the hybrid co2 tubing/cap sets for olympus® scopes & ucr leaked water at the distal at the end of the scope.Another lot number of the same part number (lot number wo473174, date of manufacturing 11/24/25, and expiration date 11/05/28) was also a part of the complaint.The sets were used with an olympus 190 series scopes, olympus co2 insufflator model ucr, and boston scientific port connectors.There were no reports of any patient injuries.
 
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Brand Name
ERBEFLO CLEVERCAP® HYBRID CO2 TUBING/CAP SETS
Common Device Name
CO2 TUBING/CAP SETS
Manufacturer (Section D)
ERBE MEDICAL. LLC
405 w geneva drive
tempe AZ 85282
Manufacturer (Section G)
ERBE MEDICAL, LLC
405 w geneva drive
tempe AZ 85282
Manufacturer Contact
john tartal
2225 northwest parkway
marietta, GA 30067-8764
7709554400
MDR Report Key24900087
Report Number3020712480-2026-00010
Device Sequence Number8677093
Product Code FEQ
UDI-Device Identifier04065655000405
UDI-Public04065655000405
Combination Product (Y/N)N
Initial Reporter StateNY
Initial Reporter CountryUS
PMA/510(K) Number
K162152
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)N
Reporter Type Manufacturer
Report Source User Facility,Company Representative
Initial Reporter Occupation Other Health Care Professional
Remedial Action Recall,Notification
Type of Report Initial
Report Date (Section B) 04/16/2026
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 Catalogue Number20325-240
Device Lot NumberWO473170
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer03/16/2026
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 03/23/2026
Initial Report FDA Received Date04/16/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured11/06/2025
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 Unknown
Patient Sequence Number1
Patient Age50 YR
Patient SexUnknown
Patient Weight68 KG
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