BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PENTAX

    MDR report key: 19507925 · Received June 11, 2024

    Report

    Report Number
    9610877-2024-54420
    Event Type
    Malfunction
    Date Received
    June 11, 2024
    Date of Event
    May 28, 2024
    Report Date
    June 11, 2024
    Manufacturer
    HOYA CORPORATION PENTAX TOKYO OFFICE
    Product Code
    EOB
    UDI-DI
    04961333239795
    PMA / PMN Number
    K171011
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    THE PRODUCT WAS RETURNED TO PENTAX MEDICAL FOR REPAIR. OUR TECHNICIAN CHECKED THE RETURNED UNIT AND CONFIRMED THAT THE IMAGE CLOUDY (NOT CLEAR VIEW). BASED ON THE RESULT, WE CONCLUDED THAT IT WAS CAUSED DUE TO THE MOISTURE CONDENSATION IN THE IMAGE. IN ADDITION, OUR TECHNICIAN CONFIRMED THAT THE BENDING RUBBER PERFORATED, AND THE OBJECTIVE LENS DIRTY; HOWEVER, THESE DEFECTS ARE NOT THE MAIN CAUSE, AND/OR IRRELEVANT TO THE ALLEGED COMPLAINT. BASED ON THE TECHNICAL REPORT "HR-RPT-0586 (IMAGE FAILURE)" AND/OR THE RISK ANALYSIS RESULTS, IT WAS EVALUATED TO SUBMIT MDR.

    Description of Event or Problem · 0

    THE TIME OF EVENT IS NOT DURING PROCEDURE. THERE WAS NO REPORT OF PATIENT HARM. VIDEO IMAGE FAILURE (CLOUDY).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    859406 PENTAX VIDEO NASOLARYNGOSCOPE (FOR VIVIDEO) EOB HOYA CORPORATION PENTAX TOKYO OFFICE VNL9-CP 04961333239795

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown