FDA Adverse Event Injury Summary report: N

EVIS EXERA III GASTROINTESTINAL VIDEOSCOPE

MDR report key: 16963942 · Received May 19, 2023

Report

Report Number
2429304-2023-00140
Event Type
Injury
Date Received
May 19, 2023
Date of Event
April 10, 2023
Report Date
May 19, 2023
Manufacturer
AIZU OLYMPUS CO., LTD.
Product Code
FDS
UDI-DI
04953170305276
Adverse Event
Yes
Product Problem
Yes
Report Source
Distributor report
Reporter Location
MI, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Description of Event or Problem · 0

OLYMPUS RECEIVED A VOLUNTARY MEDWATCH REPORT REGARDING THE EVIS EXERA III GASTROINTESTINAL VIDEOSCOPE, STATING THE USER FACILITY HAD BEEN NOTIFIED BY THE STATE OF AN E.COLI PATIENT THAT WAS HOUSED INPATIENT. UPON NOTIFICATION, CHART REVIEW AT THE USER FACILITY WAS INITIATED TO DETERMINE POSSIBLE CAUSES. DURING SAID CHART REVIEW, IT WAS FOUND THAT TWO SCOPES WERE USED ON MULTIPLE PATIENTS THAT HAD BEEN CONFIRMED TO HAVE NDM E. COLI. BOTH SCOPES HAVE BEEN SEQUESTERED FOR EXAMINATION. THE FACILITY HAS BEEN CONTACTED MULTIPLE TIMES TO CLARIFY THE EVENT AND PATIENTS, BUT NO RESPONSE HAS BEEN RECEIVED. SIX MDRS ARE REQUIRED FOR THIS EVENT, AS MULTIPLE SCOPES AND MULTIPLE PATIENTS WERE INVOLVED: PATIENT IDENTIFIER (B)(6) IS FOR PATIENT 1 (42 YEAR OLD FEMALE) FOR GIF-HQ190/ 2201760. PATIENT IDENTIFIER (B)(6) IS FOR PATIENT 2 (UNKNOWN PATIENT) FOR GIF-HQ190/ 2201760. PATIENT IDENTIFIER (B)(6) IS FOR PATIENT 3 (UNKNOWN PATIENT) FOR GIF-HQ190/ 2201760. PATIENT IDENTIFIER (B)(6) IS FOR PATIENT 1 (42 YEAR OLD FEMALE) FOR GIF-HQ190 / 2517646. PATIENT IDENTIFIER (B)(6) IS FOR PATIENT 2 (UNKNOWN PATIENT) FOR GIF-HQ190 / 2517646. PATIENT IDENTIFIER (B)(6) IS FOR PATIENT 3 (UNKNOWN PATIENT) FOR GIF-HQ190 / 2517646. THIS REPORT IS FOR PATIENT IDENTIFIER (B)(6) .

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
510812 EVIS EXERA III GASTROINTESTINAL VIDEOSCOPE GASTROINTESTINAL VIDEOSCOPE FDS AIZU OLYMPUS CO., LTD. GIF-HQ190 04953170305276

Patients

Seq Age Sex Outcome Treatment
1 42 YR Female Other