BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PENTAX

    MDR report key: 12629685 · Received October 14, 2021

    Report

    Report Number
    9610877-2021-50064
    Event Type
    Malfunction
    Date Received
    October 14, 2021
    Date of Event
    January 1, 2021
    Report Date
    October 14, 2021
    Manufacturer
    HOYA CORPORATION PENTAX TOKYO OFFICE
    Product Code
    EOB
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 0

    THIS DEVICE IS CLASSIFIED AS IMPORT FOR EXPORT, THEREFORE 510K IS NOT APPLICABLE. MODEL FNL-10RP3 IS AVAILABLE IN THE USA WITH A 510K NUMBER K951196. WE CHECKED THE RETURNED UNIT AND CONFIRMED THAT THE BENDING RUBBER PERFORATED, INSERTION FLEXIBLE TUBE (IFT) INSIDE OF THE CABLE BECAME TO "SPIRAL CLOSER" CONDITION, BENDING RUBBER LEAKY. BASED ON THE RESULT, WE CONCLUDED THAT THE IMAGE GUIDE FIBER BUNDLE (CFB) FLUID DAMAGE WAS CAUSED DUE TO THE BENDING RUBBER LEAKY; HOWEVER, OTHER FAILURE IS NOT RELATED TO THE ALLEGED COMPLAINT.

    Description of Event or Problem · 0

    THE TIME OF EVENT IS UNKNOWN. THERE WAS NO REPORT OF PATIENT HARM. FIBER IMAGE FAILURE(BROKEN).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1527638 PENTAX FIBER NASO PHARYNGO LARYNGOSCOPE EOB HOYA CORPORATION PENTAX TOKYO OFFICE FNL-10RBS

    Patients

    Seq Age Sex Outcome Treatment
    1