FDA Adverse Event Malfunction Summary report: N

VIDEO URETERO-RENOSCOPE FLEX-XC1

MDR report key: 23707249 · Received December 3, 2025

Report

Report Number
1221826-2025-02207
Event Type
Malfunction
Date Received
December 3, 2025
Date of Event
November 10, 2025
Report Date
January 27, 2026
Manufacturer
KARL STORZ ENDOVISION
Product Code
FGB
UDI-DI
04048551428023
PMA / PMN Number
K212458
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NY, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

CONCLUSION SUMMARY: INVESTIGATIONAL ACTIVITIES SUGGEST MULTIPLE ROOT CAUSES COULD POTENTIALLY BE RELATED TO IMAGE QUALITY ISSUES. IN AN EFFORT TO FURTHER INVESTIGATE THE POTENTIAL ROOT CAUSES, WE HAVE INITIATED CAPA-25-0042. WE WILL CONTINUE TO TRACK AND TREND IMAGE QUALITY ISSUES. THIS EVENT IS FILED UNDER INTERNAL COMPLAINT ID (B)(4).

Additional Manufacturer Narrative · 0

CONCLUSION SUMMARY: INVESTIGATIONAL ACTIVITIES SUGGEST MULTIPLE ROOT CAUSES COULD POTENTIALLY BE RELATED TO IMAGE QUALITY ISSUES. IN AN EFFORT TO FURTHER INVESTIGATE THE POTENTIAL ROOT CAUSES, WE HAVE INITIATED CAPA-25-0042. WE WILL CONTINUE TO TRACK AND TREND IMAGE QUALITY ISSUES. THIS EVENT IS FILED UNDER INTERNAL COMPLAINT (B)(4).

Description of Event or Problem · 0

IT WAS REPORTED THAT THE TELESCOPE DIDN'T DISPLAY AN IMAGE. NO NEGATIVE IMPACT IN STATE OF HEALTH REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2845539 VIDEO URETERO-RENOSCOPE FLEX-XC1 VIDEO URETERO-RENOSCOPE FLEX-XC1 FGB KARL STORZ ENDOVISION 091279-01 202503041 04048551428023

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown