Class 2 Device Recall BV443QA 3LUMEN EXTRACTION BALLOON V

• Date Initiated by Firm: January 04, 2021
• Create Date: February 05, 2021
• Recall Status: Terminated on March 11, 2024
• Recall Number: Z-0968-2021
• Recall Event ID: 87074
• 510(K)Number: K091495
• Product Classification: Stents, drains and dilators for the biliary ducts - Product Code FGE
• Product: B-V443Q-A 3-LUMEN EXTRACTION BALLOON V, model no. B-V443Q-A - Product Usage: Used with endoscopes to endoscopically remove stones such as calculi, pancreatic and common bile duct stones.
• Code Information: 06V, 07V, 08V, 09V, 0XV
• Recalling Firm/ Manufacturer: Aomori Olympus Co., Ltd.; 2 Chome 248-1; Okkonoki; Kuroishi Japan
• For Additional Information Contact: Laura Storms; 484-8965688
• Manufacturer Reason for Recall: Inspection confirmed a small percentage of sterile packages with inadequate package seal (partial heat seal). Patients may develop infections if non-sterile equipment is used.
• FDA Determined Cause: Under Investigation by firm
• Action: On January 4, 2021, the firm distributed Urgent Medical Device Recall letters to affected customers. Customers were informed that the identified list of Endo-therapy devices may have a defective seal which may compromise the sterility of the product. Customers were asked to take the following actions: 1. Immediately assess any product you have in stock to identify endotherapy products with affected lot numbers listed in the recall letter. Cease use of product and quarantine any affected product. 2. Call your Olympus customer service representative at 1-888-524-7266 to obtain a Returned Goods Authorization so that you may return the product with no charge to you. Olympus will issue a credit or replacement to your facility for any returned product. 3. Access the Olympus recall portal to indicate that you have received this notification. Go to https://olympusamerica.com/recall. Enter the recall number Recall-0391 and provide your contact information as indicated in the portal. 4. If you have distributed these devices outside your facility, please notify your customers of this corrective action immediately. Your notification to your customers may be enhanced by including a copy of this recall notification letter.
• Quantity in Commerce: 7,400,000 (global); 260,395 (US)
• Distribution: US Nationwide distribution.
• Total Product Life Cycle: TPLC Device Report

¹ A record in this database is created when a firm initiates a correction or removal action. The record is updated if the FDA identifies a violation and classifies the action as a recall, and it is updated for a final time when the recall is terminated. Learn more about medical device recalls.
² Per FDA policy, recall cause determinations are subject to modification up to the point of termination of the recall.
³ For details about termination of a recall see Code of Federal Regulations (CFR) Title 21 §7.55.

• 510(K) Database: 510(K)s with Product Code = FGE and Original Applicant = OLYMPUS MEDICAL SYSTEMS CORPORATION