FDA Adverse Event
Malfunction
Summary report: N
VIDEO TELESCOPE "ENDOEYE HD II", 10 MM, 0°, AUTOCLAVABLE
MDR report key: 25124706
·
Received May 8, 2026
Report
- Report Number
- 9610773-2026-03633
- Event Type
- Malfunction
- Date Received
- May 8, 2026
- Date of Event
- April 1, 2026
- Report Date
- May 8, 2026
- Manufacturer
- OLYMPUS WINTER & IBE GMBH
- Product Code
- HET
- UDI-DI
- 04042761074964
- PMA / PMN Number
- K190744
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- EI
- Reporter Occupation
- 003
Narratives
Additional Manufacturer Narrative · 0
THE DEVICE WAS RETURNED TO OLYMPUS FOR INSPECTION. A ROOT CAUSE COULD NOT BE IDENTIFIED. BASED ON THE RESULTS OF THE INVESTIGATION, THE MOST PROBABLE CAUSE OF THE OUTER TUBE TRACED TO COMPONENT FAILURE. HOWEVER, THE CAUSE OF THE FOREIGN MATERIAL OBSERVED IN THE LASER LIGHT CABLE (LLK PLUG) OF THE VIDEO CABLE SECTION COULD NOT BE ESTABLISHED. SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. OLYMPUS WILL CONTINUE TO MONITOR FIELD PERFORMANCE FOR THIS DEVICE.
Description of Event or Problem · 0
IT WAS OBSERVED THAT DURING THE DEVICE EVALUATION, THE RIGID VIDEO LAPAROSCOPE HAD DENTED OUTER TUBE AND FOREIGN MATERIAL IN THE LASER LIGHT CABLE (LLK PLUG) OF THE VIDEO CABLE SECTION. THERE WAS NO PATIENT INVOLVEMENT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 49699 | VIDEO TELESCOPE "ENDOEYE HD II", 10 MM, 0°, AUTOCLAVABLE | RIGID VIDEO LAPAROSCOPE | HET | OLYMPUS WINTER & IBE GMBH | WA50040A | 04042761074964 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | NA | Unknown |