MAUDE Adverse Event Report: UNITED STATES ENDOSCOPY GROUP, INC. BIOSHIELD BIOPSY VALVE

Model Number	00711125
Health Effect - Clinical Code	Exposure to Body Fluids (1745)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The bioshield biopsy valve is used to cover the opening to the biopsy/suction channel inlet of a gastrointestinal endoscope.The bioshield biopsy valve provides access for endoscopic device passage and exchange, helps maintain insufflation and minimizes leakage of biomaterial from the biopsy port throughout the gastrointestinal endoscopic procedure.Facility personnel were wearing ppe and there was no reported treatment due to contact with fluids.The device history record was reviewed and confirmed the devices were manufactured to specification.There have been no other complaints associated with this lot.The instructions for use include the following statements: "do not leave a device hanging from the valve.Doing so can cause the creation of a larger valve slit/hole that may cause leakage.If the lid of the valve is opened while attached to the endoscope during a procedure, scope suction will be compromised and leakage may occur.If leakage occurs, a sterile gauze should be used to cover the valve.".
Event or Problem Description
The distributor in the (b)(4) received report of bodily fluid spray with resultant patient and user contact during passage of devices through bioshield biopsy valves.

• Brand Name: BIOSHIELD BIOPSY VALVE
• Common Device Name: BIOPSY VALVE
• Manufacturer (Section D): UNITED STATES ENDOSCOPY GROUP, INC.; 5976 heisley rd; mentor OH 44060
• MDR Report Key: 7786146
• Report Number: 1528319-2018-00023
• Device Sequence Number: 1052781
• Product Code: ODD
• UDI-Device Identifier: 00816765013397
• UDI-Public: (01)00816765013397
• Combination Product (Y/N): N
• Initial Reporter Country: NL
• PMA/510(K) Number: K070420
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: distributor,foreign
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 08/15/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 02/26/2021
• Device Model Number: 00711125
• Device Catalogue Number: 00711125
• Device Lot Number: 1802882
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 07/16/2018
• Initial Report FDA Received Date: 08/15/2018
• Patient Sequence Number: 1