FDA Adverse Event Malfunction Summary report: N

VIDEO URETEROSCOPE, 8.5 FR. X 700MM

MDR report key: 24676403 · Received March 24, 2026

Report

Report Number
1221826-2026-00613
Event Type
Malfunction
Date Received
March 24, 2026
Date of Event
March 11, 2026
Report Date
April 29, 2026
Manufacturer
KARL STORZ ENDOVISION
Product Code
FGB
PMA / PMN Number
K141250
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NC, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE DEVICE WILL 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).

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).

Description of Event or Problem · 0

IT WAS REPORTED THAT THE SHEATH IS PEELING OFF AT END. NO NEGATIVE IMPACT IN STATE OF HEALTH REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
351944 VIDEO URETEROSCOPE, 8.5 FR. X 700MM VIDEO URETEROSCOPE, 8.5 FR. X 700MM FGB KARL STORZ ENDOVISION R11278VSUEK

Patients

Seq Age Sex Outcome Treatment
1