MAUDE Adverse Event Report: HOYA CORPORATION PENTAX TOKYO OFFICE PENTAX; VIDEO GASTROSCOPE

Model Number EG29-I10

Device Problem Ventilation Problem in Device Environment (3027)

Patient Problem Chemical Exposure (2570)

Event Date 11/09/2019

Event Type  Injury  

Manufacturer Narrative

(b)(4).Related mdrs: mdr 9610877-2019-01560 for technician 01 (gastroscope family (lower gi) - ec family); mdr 9610877-2019-01561 for technician 01 (gastroscope family (upper gi) - eg family); mdr 9610877-2019-01567 for technicain 02 (gastroscope family (lower gi) - ec family); mdr 9610877-2019-01568 for technicain 02 (gastroscope family (upper gi) - eg family).

Event Description

Pentax medical was made aware of a complaint on 16-nov-2019, that occurred during reprocessing on (b)(6) 2019 in (b)(6).The reported complaint that two technicians underwent "exposure to high isopropyl alcohol vapors while pre-sterilizing scopes during the alcohol flush" involving multiple pentax medical i10 series endoscopes.After being made aware of the events on the final day of the demo, (b)(6) 2019, pentax (b)(6) provided the option to the hospital to no longer use alcohol to flush and move to air.The first technician was assessed and was admitted to the emergency room, although the condition was not considered life threatening.The tech was assessed and referred to an ent [ear, nose, throat specialist].The patient was not recalled for further screening and the technician is still symptomatic.When asked if the technician was wearing proper ppe (personal protective equipment), inadequate ventilation was noted.The technician was exposure to s40 sterilant on (b)(6) 2019 following an equipment malfunction.The endoscopes involved were a group of demo units reprocessed including the following models and serial numbers.Ec38-i10nl = (b)(4).Since it was a demonstration, the exact models and serial numbers processed by each technician were not recorded in detail so it remains unclear which endoscopes were reprocessed by which technician.As there was no suspected malfunction of the pentax medical endoscope only one mdr report will be filed for each technician for both the colonoscope and gastroscope product families.Device history record(dhr) reviews were performed for each endoscope serial number and are documented below.On 13-dec-2019, a device history record(dhr) review was performed under ivai-19-120040, the dhr review confirmed all of the following endoscopes were manufactured under normal conditions, passed all required inspections, and were released accordingly.Also, there were no reworks or concessions and the dates of approval for shipment and actual date shipped were confirmed.Below are the manufacturing and ship dates for each serial number: model: ec38-i10nl, serial number: (b)(4), manufacturing date: 04-apr-2017, shipment date: 18-may-2017; model: ec38-i10nl, serial number: (b)(4), manufacturing date: 21-apr-2017, shipment date: 18-may-2017; model: ec38-i10nl, serial number: (b)(4), manufacturing date: 04-apr-2017, shipment date: 18-may-2017; model: ec38-i10nl, serial number: (b)(4), manufacturing date: 10-oct-2017, shipment date: 11-oct-2017; model: ec38-i10nl, serial number: (b)(4), manufacturing date: 13-oct-2017, shipment date: 17-oct-2017; model: ec38-i10nl, serial number: (b)(4), manufacturing date: 13-oct-2017, shipment date: 17-oct-2017.Model: eg29-i10, serial number: (b)(4), manufacturing date: 24-jun-2017, shipment date: 24-jun-2017; model: eg29-i10, serial number: (b)(4), manufacturing date: 11-jan-2018, shipment date: 12-jan-2018; model: eg29-i10, serial number: (b)(4), manufacturing date: 11-jan-2018, shipment date: 12-jan-2018; model: eg29-i10, serial number: (b)(4), manufacturing date: 11-jan-2018, shipment date: 12-jan-2018.The investigation is currently in-process.

• Brand Name: PENTAX
• Type of Device: VIDEO GASTROSCOPE
• Manufacturer (Section D): HOYA CORPORATION PENTAX TOKYO OFFICE; tsutsujigaoka 1-1-110; akishima-shi; tokyo, 196-0 012; JA 196-0012
• Manufacturer (Section G): HOYA CORPORATION PENTAX TOKYO OFFICE; tsutsujigaoka 1-1-110; akishima-shi; tokyo, 196-0 012; JA 196-0012
• Manufacturer Contact: william goeller (temporary) ; 3 paragon drive; montvale, NJ 07645 ; 8004315880
• MDR Report Key: 9468008
• MDR Text Key: 187614401
• Report Number: 9610877-2019-01561
• Device Sequence Number: 1
• Product Code: FDS
• Combination Product (y/n): N
• Reporter Country Code: CA
• PMA/PMN Number: K131902
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,health professional
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 11/16/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/13/2019
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: EG29-I10
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 11/16/2019
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Age: 33 YR