FDA Adverse Event Malfunction Summary report: N

VIDEO URETERO-RENOSCOPE FLEX-XC1

MDR report key: 24531428 · Received March 6, 2026

Report

Report Number
1221826-2026-00469
Event Type
Malfunction
Date Received
March 6, 2026
Date of Event
February 19, 2026
Report Date
April 6, 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).

Additional Manufacturer Narrative · 0

THE DEVICE WILL NOT BE FORWARDED TO THE MANUFACTURER FOR FURTHER INVESTIGATION. SHOULD RELEVANT ADDITIONAL INFORMATION / INVESTIGATION RESULTS BECOME AVAILABLE, A SUPPLEMENTAL MEDWATCH REPORT WILL BE SUBMITTED UNSOLICITED. THIS EVENT IS FILED UNDER INTERNAL COMPLAINT ID (B)(4).

Description of Event or Problem · 0

THE FOLLOWING WAS REPORTED: NOT FUNCTIONING PROPERLY. NO NEGATIVE IMPACT IN STATE OF HEALTH REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
593029 VIDEO URETERO-RENOSCOPE FLEX-XC1 VIDEO URETERO-RENOSCOPE FLEX-XC1 FGB KARL STORZ ENDOVISION 091279-01 202510311 04048551428023

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown