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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: AOMORI OLYMPUS CO., LTD. THUNDERBEAT 5 MM, 35 CM, FRONT-ACTUATED GRIP TYPE S; ULTRASONIC SURGICAL DEVICE

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AOMORI OLYMPUS CO., LTD. THUNDERBEAT 5 MM, 35 CM, FRONT-ACTUATED GRIP TYPE S; ULTRASONIC SURGICAL DEVICE Back to Search Results
Model Number TB-0535FCS
Medical Device Problem Code Detachment of Device or Device Component (2907)
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 was returned to olympus for inspection.A definitive root cause could not be identified.Based on the results of the investigation, it is likely the following led to the malfunction: cause not established.Olympus will continue to monitor field performance for this device.Should additional relevant information become available, a supplemental report will be submitted.
 
Event or Problem Description
It was observed that during the device inspection, exhibited the broken portion (shaft) exhibited a characteristic of ductile fracture.There were no reports of patient involvement.
 
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Brand Name
THUNDERBEAT 5 MM, 35 CM, FRONT-ACTUATED GRIP TYPE S
Common Device Name
ULTRASONIC SURGICAL DEVICE
Manufacturer (Section D)
AOMORI OLYMPUS CO., LTD.
2-248-1 okkonoki
kuroishi-shi, aomori 036-0 357
JA  036-0357
Manufacturer (Section G)
AOMORI OLYMPUS CO., LTD.
2-248-1 okkonoki
kuroishi-shi, aomori 036-0 357
JA   036-0357
Manufacturer Contact
todd brill
800 west park drive
westborough, MA 01581
5082077661
MDR Report Key25369094
Report Number9614641-2026-00580
Device Sequence Number18783713
Product Code GEI
UDI-Device Identifier04953170383557
UDI-Public04953170383557
Combination Product (Y/N)N
Initial Reporter CountryKS
PMA/510(K) Number
K211838
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) 06/02/2026
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 NumberTB-0535FCS
Device Lot Number54K14
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer04/30/2026
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 05/19/2026
Initial Report FDA Received Date06/02/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured04/14/2025
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 Initial
Patient Sequence Number1
Patient SexUnknown
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