| Brand Name | HF-CABLE, BIPOLAR |
| Common Device Name | ELECTRICAL-ONLY MEDICAL DEVICE CONNECTION CABLE, REUSABLE |
| Manufacturer (Section D) |
| OLYMPUS WINTER & IBE GMBH |
| kuehnstrasse 61 |
| hamburg, hamburg 22045 |
| GM 22045 |
|
| Manufacturer (Section G) |
| OLYMPUS WINTER & IBE GMBH |
| kuehnstrasse 61 |
|
| hamburg, hamburg 22045 |
|
GM
22045
|
|
| Manufacturer Contact |
|
todd
brill
|
| 800 west park drive |
| westborough, MA 01581
|
|
5082077661
|
|
| MDR Report Key | 25735167 |
| Report Number | 9610773-2026-04770 |
| Device Sequence Number | 10358315 |
| Product Code |
FAS
|
| UDI-Device Identifier | 04042761076449 |
| UDI-Public | 04042761076449 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | GM |
| PMA/510(K) Number | K120418 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Health Professional,User Facility |
| Initial Reporter Occupation |
Nurse
|
| Remedial Action |
Notification |
| Type of Report
| Initial |
| Report Date (Section B) |
07/07/2026 |
| 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 Number | WA00014A |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 03/13/2026 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Initial |
| Initial Date Received by Manufacturer | 02/27/2026 |
| Initial Report FDA Received Date | 07/07/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| 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
|
If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement | 3002807798-02/23/2026-00 |
| Patient Sequence Number | 1 |
Concomitant Medical Products and Therapy/Usage Dates | (B)(4). |
| Patient Sex | Unknown |
|
|