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U.S. Department of Health and Human Services

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

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AIZU OLYMPUS CO., LTD. EVIS EXERA II DUODENOVIDEOSCOPE Back to Search Results
Model Number TJF-Q180V
Medical Device Problem Code Microbial Contamination of Device (2303)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 04/07/2026
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that, during reprocessing, the duodenovideoscope tested positive on (b)(6) 2026 for 10-100 cfus (colony forming units) of citrobacter freundii.The device was retested on (b)(6) 2026, and it tested positive for 10-100 cfus of citrobacter freundii and 1-10 cfus of enterococcus faecalis.The device was tested again on (b)(6) 2026, and tested positive for 1-10 cfus of citrobacter freundii.The device was tested again on (b)(6) 2026 for 1-10 cfus of citrobacker braakii.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.
 
Additional Manufacturer Narrative
This supplemental report is being submitted to provide the results of the final investigation.Based on the results of the investigation, the reported event was confirmed, and a root cause could not be established.Growth of microorganisms were reported through culture testing by the user after reprocessing.However, the scope was not microbiologically tested by olympus.Olympus will continue to monitor field performance for this device.
 
Event or Problem Description
No additional information provided by the customer.
 
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Brand Name
EVIS EXERA II 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 Key25060070
Report Number9610595-2026-35762
Device Sequence Number9354284
Product Code FDT
UDI-Device Identifier04953170339967
UDI-Public04953170339967
Combination Product (Y/N)N
Initial Reporter CountryAS
PMA/510(K) Number
K143153
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 Other Health Care Professional
Type of Report Initial,Followup
Report Date (Section B) 06/16/2026
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 Model NumberTJF-Q180V
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer04/07/2026
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Follow-Up
Initial Date Received by Manufacturer 04/07/2026
Supplement Date Received by Manufacturer06/03/2026
Initial Report FDA Received Date05/01/2026
Supplement Report FDA Received Date06/16/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured01/31/2018
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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