FDA Adverse Event Malfunction Summary report: N

FLUSHING PUMP OFP-2 (JP)

MDR report key: 19726405 · Received July 11, 2024

Report

Report Number
9611174-2024-01321
Event Type
Malfunction
Date Received
July 11, 2024
Report Date
August 19, 2025
Manufacturer
KEYMED (MEDICAL AND INDUSTRIAL EQUIPMENT) LTD.
Product Code
FEQ
PMA / PMN Number
K100899
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

E2/E3: NO INFORMATION AVAILABLE FOR THE OCCUPATION OF THE INITIAL REPORTER OR WHETHER THEY ARE A HEALTHCARE PROFESSIONAL THE INVESTIGATION IS ONGOING. A SUPPLEMENTAL REPORT WILL BE SUBMITTED WHEN THE INVESTIGATION IS COMPLETED OR IF ADDITIONAL INFORMATION BECOMES AVAILABLE.

Additional Manufacturer Narrative · 0

THIS SUPPLEMENTAL REPORT IS BEING SUBMITTED TO PROVIDE THE RESULTS OF THE FINAL INVESTIGATION. UPDATED FIELDS: D9, H2, H3, H4, H6, H1. THE DEVICE WAS RETURNED TO OLYMPUS FOR INSPECTION AND THE REPORTED FAILURE WAS CONFIRMED. A DEFINITIVE ROOT CAUSE COULD NOT BE IDENTIFIED. BASED ON THE RESULTS OF THE INVESTIGATION, IT IS LIKELY THE FOLLOWING LED TO THE MALFUNCTION: A COMPONENT FAILURE OF PUMP HEAD. A REVIEW OF THE DEVICE HISTORY RECORD FOUND NO DEVIATIONS THAT COULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED ISSUE. SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. OLYMPUS WILL CONTINUE TO MONITOR FIELD PERFORMANCE FOR THIS DEVICE.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE FLUSHING PUMP HAD A MALFUNCTION. THERE WERE NO REPORTS OF PATIENT HARM.

Description of Event or Problem · 0

NO ADDITIONAL INFORMATION RECEIVED FROM CUSTOMER.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
314904 FLUSHING PUMP OFP-2 (JP) OLYMPUS FLUSHING PUMP FEQ KEYMED (MEDICAL AND INDUSTRIAL EQUIPMENT) LTD. K10001142

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown