FDA Adverse Event Malfunction Summary report: N

FLUSHING PUMP OFP-2 (JP)

MDR report key: 20033585 · Received August 22, 2024

Report

Report Number
9611174-2024-01445
Event Type
Malfunction
Date Received
August 22, 2024
Date of Event
August 7, 2024
Report Date
October 28, 2024
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

A REVIEW OF THE DEVICE HISTORY RECORD FOUND NO DEVIATIONS THAT COULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED ISSUE. THE DEVICE WAS RETURNED TO OLYMPUS FOR INSPECTION, AND THE REPORTABLE MALFUNCTION 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: COMPONENT FAILURE OF THE PUMP HEAD. OLYMPUS WILL CONTINUE TO MONITOR FIELD PERFORMANCE FOR THIS DEVICE.

Description of Event or Problem · 0

IT WAS REPORTED, THAT THE FLUSHING PUMP WAS OCCASIONALLY UNSTABLE. THERE WERE NO REPORTS OF PATIENT HARM AS A RESULT OF THIS EVENT.

Description of Event or Problem · 0

IT WAS REPORTED, THAT THE FLUSHING PUMP WAS OCCASIONALLY UNSTABLE. THE INTENDED PROCEDURE WAS COMPLETED WITH A SIMILAR DEVICE. THERE WERE NO REPORTS OF PATIENT HARM AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
941056 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 GIF-H290T.