| Brand Name | AIA-2000 |
| Common Device Name | Fluorometer, For Clinical Use |
| Manufacturer (Section D) |
| Tosoh Bioscience, Inc. (Ohio) |
| 3600 gantz rd |
| grove city OH 43123 |
|
| Manufacturer (Section G) |
| Tosoh Bioscience, Inc. (Ohio) |
| 3600 gantz rd |
|
| grove city OH 43123 |
|
| Manufacturer Contact |
|
janefrances
ajiduah
|
| 2-2-1 yaesu |
| chuo-ku, tokyo 10400-28
|
|
JA
1040028
|
|
+1(650)636-8314
|
|
| MDR Report Key | 50256552 |
| Report Number | 3005529799-2026-00008 |
| Device Sequence Number | 21366090 |
| Product Code |
KHO
|
| UDI-Device Identifier | 04560189284616 |
| UDI-Public | 04560189284616 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MO |
| Initial Reporter Country | US |
| PMA/510(K) Number | K971103 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
08/14/2026 |
| 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 Number | AIA-2000ST REFURBISHED |
| Device Catalogue Number | 022100R |
| Device Lot Number | na |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/27/2026 |
| Initial Report FDA Received Date | 08/14/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 05/21/2024 |
| 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
|
| Usage of Device |
Reuse
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|