FDA Adverse Event Malfunction Summary report: N

VIDEO URETERO-RENOSCOPE FLEX-XC1

MDR report key: 24502336 · Received March 3, 2026

Report

Report Number
1221826-2026-00423
Event Type
Malfunction
Date Received
March 3, 2026
Date of Event
February 12, 2026
Report Date
March 3, 2026
Manufacturer
KARL STORZ ENDOVISION
Product Code
FGB
UDI-DI
04048551428023
PMA / PMN Number
K212458
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
OH, 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). CROSS REFERENCE COMPLAINT ID: (B)(4).

Description of Event or Problem · 0

IT WAS REPORTED THAT THE ENDOSCOPES HAD IMAGE INTERFERENCE DURING PROCEDURE. NO NEGATIVE IMPACT IN STATE OF HEALTH REPORTED. CROSS REFERENCE MDR: 1221826-2026-00424.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
556095 VIDEO URETERO-RENOSCOPE FLEX-XC1 VIDEO URETERO-RENOSCOPE FLEX-XC1 FGB KARL STORZ ENDOVISION 091279-01 202509021 04048551428023

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown