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U.S. Department of Health and Human Services

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

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HOYA CORPORATION PENTAX TOKYO OFFICE PENTAX MEDICAL; VIDEO BRONCHOSCOPE Back to Search Results
Model Number EB15-J10
Medical Device Problem Code Obstruction of Flow (2423)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 02/25/2026
Type of Reportable Event Malfunction
Event or Problem Description
The time of event is unknown.There was no report of patient harm.Operation/suction channel clogged.
 
Additional Manufacturer Narrative
The product was returned to pentax medical for repair.Our technician checked the returned unit and confirmed that the operation channel (primary) stuck accessory/object.Based on the result, we concluded that it was caused due to the inadequate/insufficient reprocessing at the facility on the operation channel (primary).Based on the technical report "hr-rpt-0588(channel)" and/or the risk analysis results, it was evaluated to submit mdr.
 
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Brand Name
PENTAX MEDICAL
Common Device Name
VIDEO BRONCHOSCOPE
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
paresh patel
3 paragon drive
montvale, NJ 07645
8004315880
MDR Report Key24602420
Report Number9610877-2026-50594
Device Sequence Number9417499
Product Code EOQ
UDI-Device Identifier04961333221486
UDI-Public(01)04961333221486(11)220606
Combination Product (Y/N)N
Initial Reporter StateNC
Initial Reporter CountryUS
PMA/510(K) Number
K200678
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source Health Professional
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 03/16/2026
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Operator of Device Health Professional
Device Model NumberEB15-J10
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer02/25/2026
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 02/25/2026
Initial Report FDA Received Date03/16/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured06/06/2022
Is the Device Labeled for Single Use? (Y/N) No
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Patient Sequence Number1
Patient SexUnknown
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