BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INTELECT ADVANCED 2CH COLOR COMBO W/EMG

    MDR report key: 1180919 · Received September 29, 2008

    Report

    Report Number
    1022819-2008-00235
    Event Type
    Malfunction
    Date Received
    September 29, 2008
    Date of Event
    May 15, 2007
    Report Date
    May 15, 2007
    Manufacturer
    CHATTANOOGA GROUP
    Product Code
    IPF
    Removal / Correction Number
    1022819-11/15/2007-001-C
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SF
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THIS DEVICE IS FOR EXPORT ONLY.

    Description of Event or Problem · 1

    PT SHOCKED DURING TREATMENT ON CHANNEL 1. THIS MALFUNCTION CAUSES THE PRINTED CIRCUIT BOARD TO CHANGE THE STIMULATORY PT OUTPUT FROM THE INTENDED OUTPUT TO AN UNINTENDED HIGHER VOLTAGE OUTPUT. WHEN SUCH A MALFUNCTION OCCURS, IT RESULTS IN A SHOCK SENSATION AND POSSIBLE BURN TO THE AREA BENEATH THE ELECTRODE PADS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INTELECT ADVANCED 2CH COLOR COMBO W/EMG IPF, IMG, GZJ, HCC, GZI IPF CHATTANOOGA GROUP 2762CC

    Patients

    Seq Age Sex Outcome Treatment
    1