FDA Adverse Event Malfunction Summary report: N

MONARCH PLATFORM

MDR report key: 15494493 · Received September 27, 2022

Report

Report Number
3014447948-2022-00034
Event Type
Malfunction
Date Received
September 27, 2022
Date of Event
September 6, 2022
Report Date
September 27, 2022
Manufacturer
AURIS HEALTH, INC.
Product Code
EOQ
UDI-DI
B634MON000005010
PMA / PMN Number
K211493
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MI, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE FIELD SERVICE ENGINEER (FSE) WENT ONSITE PERFORMED A PHYSICAL INSPECTION OF THE CAMERA PATHWAY, PERFORMED A FUNCTIONAL CHECK OF THE VISION PATHWAY USING A SCOPE AND WAS NOT ABLE TO REPLICATE THE ISSUE. AS SUCH, A CAUSE COULD NOT BE DETERMINED. NO REVIEW OF THE DEVICE HISTORY RECORD (DHR) IS NECESSARY AS THE ISSUE COULD NOT BE CONFIRMED OR REPLICATED. A REVIEW FOR SIMILAR REPORTED ISSUE NOTES THIS TO BE A KNOWN ISSUE BUT HAS NOT ESTABLISHED A POSSIBLE ROOT CAUSE. THE RISK ASSOCIATED WITH THE REPORTED ISSUE IS NOTED IN: RISK DOCUMENT NUMBER: 105-000367-00, REV. M, DFMEA BRONCH 2.0 RISK ID: FMEA-1240 & FMEA-0510.

Description of Event or Problem · 0

IT WAS REPORTED THE PHYSICIAN LOST THE LIVE CAMERA IMAGE AFTER COMPLETING THE NAVIGATION REGISTRATION AND STARTED TO DRIVE OUT TO THE TARGET. THE PHYSICIAN PROACTIVELY POWER CYCLED THE SYSTEM AND CHANGED OUT THE SCOPE; HOWEVER THE ISSUE PERSISTED. THE PHYSICIAN WAS UNABLE TO PERFORM THE MONARCH PROCEDURE DUE TO THE SYSTEM RELATED ISSUE, THE CASE WAS ABORTED AND RESCHEDULED FOR A LATER DATE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1952771 MONARCH PLATFORM BRONCHOSCOPE (FLEXIBLE OR RIGID) AND ACCESSORIES EOQ AURIS HEALTH, INC. MON-000005-01 B634MON000005010

Patients

Seq Age Sex Outcome Treatment
1 Unknown