FDA Adverse Event Injury Summary report: N

EVIS EUS ULTRASOUND BRONCHOFIBERVIDEOSCOPE

MDR report key: 25332129 · Received May 29, 2026

Report

Report Number
2429304-2026-00062
Event Type
Injury
Date Received
May 29, 2026
Date of Event
April 9, 2026
Report Date
May 29, 2026
Manufacturer
SHIRAKAWA OLYMPUS CO., LTD.
Product Code
PSV
UDI-DI
04953170399831
Adverse Event
Yes
Report Source
Distributor report
Reporter Location
NY, US
Reporter Occupation
NURSE
Health Professional
Yes

Narratives

Description of Event or Problem · 0

THE USER FACILITY REPORTED A POTENTIAL MYCOBACTERIUM IMMUNOGENUM INFECTION CONCERN ASSOCIATED WITH THE USE OF THE BRONCHOFIBERVIDEOSCOPE. THE DEVICE WAS REPORTEDLY USED DURING A BRONCHOSCOPY PROCEDURE. FOLLOWING THE PROCEDURE, A BRONCHOALVEOLAR LAVAGE (BAL) SPECIMEN COLLECTED FROM THE PATIENT REPORTEDLY IDENTIFIED MYCOBACTERIUM IMMUNOGENUM. THE PATIENT WAS REFERRED TO INFECTIOUS DISEASE FOR FOLLOW-UP. NO PATIENT SYMPTOMS, TREATMENT DETAILS, FINAL DIAGNOSIS, HOSPITALIZATION INFORMATION, OR PATIENT OUTCOME WERE PROVIDED. THE CUSTOMER REPORTED THAT THE PATIENT WAS NOT A CARRIER PRIOR TO THE PROCEDURE. THE CUSTOMER FURTHER REPORTED THAT THE DEVICE UNDERWENT REPROCESSING PER FACILITY PROTOCOL AND WAS SUBSEQUENTLY QUARANTINED FOR EVALUATION. NO DEVICE MALFUNCTION WAS ALLEGED. ADDITIONALLY, NO POSITIVE CULTURE RESULTS FROM THE SUBJECT DEVICE HAVE BEEN REPORTED, AND THE SOURCE OF THE DETECTED MICROORGANISM REMAINS UNDER INVESTIGATION. THE CUSTOMER ALSO INDICATED THAT ENVIRONMENTAL SOURCES ARE BEING EVALUATED AS PART OF THE ONGOING INVESTIGATION. THIS REPORT REPRESENTS 4 OF 17 RELATED PATIENT REPORTS ASSOCIATED WITH THE REPORTED INFECTION CLUSTER.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
620723 EVIS EUS ULTRASOUND BRONCHOFIBERVIDEOSCOPE BRONCHOFIBERVIDEOSCOPE PSV SHIRAKAWA OLYMPUS CO., LTD. BF-UC190F 04953170399831

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown