FDA Adverse Event Malfunction Summary report: N

EVIS LUCERA ELITE GASTROINTESTINAL VIDEOSCOPE

MDR report key: 22207467 · Received June 13, 2025

Report

Report Number
9610595-2025-11217
Event Type
Malfunction
Date Received
June 13, 2025
Report Date
July 30, 2025
Manufacturer
AIZU OLYMPUS CO., LTD.
Product Code
FDS
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
NURSE
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

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: D8, G1, G2, H6 CORRECTED FIELDS: E2 - FROM N TO Y E3 - FROM N/A TO NURSE H6 (COMPONENT CODE) - FROM PROCESSOR TO IMAGER THE DEVICE WAS NOT RETURNED TO OLYMPUS FOR INSPECTION HOWEVER, THE REPORTED FAILURE WAS CONFIRMED. BASED ON THE RESULTS OF THE INVESTIGATION, A DEFINITIVE ROOT CAUSE COULD NOT BE IDENTIFIED. THE EVENT IS DETECTABLE/PREVENTABLE BY HANDLING THE DEVICE IN ACCORDANCE WITH THE FOLLOWING IFU: AN INSUFFICIENTLY REPROCESSED ENDOSCOPE AND/OR ACCESSORY MAY POSE AN INFECTION CONTROL RISK TO THE PATIENTS AND/OR OPERATORS WHO TOUCH THEM. OLYMPUS WILL CONTINUE TO MONITOR FIELD PERFORMANCE FOR THIS DEVICE.

Description of Event or Problem · 0

IT WAS REPORTED THE SUBJECT DEVICE EXHIBITED THE WATER FILTER HAD NOT BEEN REPLACED FOR ONE YEAR. THE ISSUE OCCURRED DURING REPROCESSING. THERE WERE NO REPORTS OF PATIENT INVOLVEMENT.

Description of Event or Problem · 0

NO ADDITIONAL INFORMATION RECEIVED FROM CUSTOMER.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
344308 EVIS LUCERA ELITE GASTROINTESTINAL VIDEOSCOPE GASTROINTESTINAL VIDEOSCOPE FDS AIZU OLYMPUS CO., LTD. GIF-H290

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown