FDA Adverse Event Malfunction Summary report: N

(C-MAC VIDEO LARYNGOSCOPE MAC #3)

MDR report key: 20954551 · Received December 17, 2024

Report

Report Number
9610617-2024-00515
Event Type
Malfunction
Date Received
December 17, 2024
Report Date
March 13, 2025
Manufacturer
KARL STORZ SE & CO. KG
Product Code
CCW
PMA / PMN Number
EXEMPT
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
UK
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

RESULT OF INVESTIGATION: THE ERROR DESCRIPTION PROVIDED BY THE CUSTOMER (POOR VIDEO IMAGES AND NO VIDEO IMAGES) COULD NOT BE CONFIRMED BECAUSE THE PRODUCT WAS NOT SENT TO KST FOR EXAMINATION. BASED ON OUR OWN EXPERIENCE AND SIMILAR COMPLAINTS, THE MOST LIKELY ROOT CAUSE IS WEAR OF THE ADHESIVE AT THE TIP OF THE C-MAC BLADE CAUSED BY THE REPROCESSING PROCESS. THIS CAUSES LIQUID TO PENETRATE THE BLADE, WHICH AFFECTS THE ELECTRONICS AND CAUSES THE LED TO FAIL/BE DIM. IN ADDITION, THE IMAGE SENSOR IS AFFECTED BY THE INGRESS OF LIQUID, WHICH CAN CAUSE THE IMAGE TO FAIL. THE INSTRUCTIONS FOR USE DESCRIBE THAT A FUNCTIONAL AND VISUAL INSPECTION MUST BE CARRIED OUT BEFORE USE, DURING WHICH SIGNS OF WEAR AND DAMAGE TO THE C-MAC VIDEO LARYNGOSCOPE WOULD HAVE BEEN DETECTED. THE EVENT IS FILED UNDER INTERNAL KARL STORZ COMPLAINT ID: (B)(4).

Additional Manufacturer Narrative · 0

THE AFFECTED DEVICE HAS BEEN REQUESTED FOR INVESTIGATION BY THE MANUFACTURER. THE DEVICE WAS NOT YET RETURNED FOR INVESTIGATION. CROSS REFERENCE COMPLAINT ID: (B)(4). THE EVENT IS FILED UNDER INTERNAL KARL STORZ COMPLAINT ID: (B)(4).

Description of Event or Problem · 0

IT WAS REPORTED THAT "POOR VIDEO IMAGES AND NO VIDEO IMAGES." NO NEGATIVE IMPACT IN STATE OF HEALTH REPORTED. CROSS REFERENCE MDR 9610617-2024-00516 9610617-2024-00517.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1486340 (C-MAC VIDEO LARYNGOSCOPE MAC #3) C-MAC VIDEO LARYNGOSCOPE MAC #3 CCW KARL STORZ SE & CO. KG 8404AXC

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown