BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VIDEO COLONOSCOPE 4.2C 13.2T 1700L FWJ

    MDR report key: 19903869 · Received August 5, 2024

    Report

    Report Number
    9610877-2024-55907
    Event Type
    Malfunction
    Date Received
    August 5, 2024
    Date of Event
    July 29, 2024
    Report Date
    August 5, 2024
    Manufacturer
    HOYA CORPORATION PENTAX TOKYO OFFICE
    Product Code
    FDF
    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 CCD MODULE WITH DRIVE PCB CLOUDY (NOT CLEAR VIEW). BASED ON THE RESULT, WE CONCLUDED THAT IT WAS CAUSED DUE TO THE MOISTURE CONDENSATION IN THE CCD MODULE WITH DRIVE PCB. IN ADDITION, OUR TECHNICIAN CONFIRMED THAT THE LCB DISTAL COVER GLASS DIRTY; HOWEVER, THIS DEFECT IS NOT THE MAIN CAUSE, AND/OR IRRELEVANT TO THE ALLEGED COMPLAINT. THIS DEFECT OCCURRED NOT DURING PROCEDURE. 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
    2265738 VIDEO COLONOSCOPE 4.2C 13.2T 1700L FWJ FDF

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown