FDA Adverse Event Malfunction Summary report: N

DRX REVOLUTION MOBILE X-RAY SYSTEM

MDR report key: 18383235 · Received December 22, 2023

Report

Report Number
1317307-2023-00012
Event Type
Malfunction
Date Received
December 22, 2023
Date of Event
November 14, 2023
Report Date
March 6, 2024
Manufacturer
CARESTREAM HEALTH INC.
Product Code
IZL
UDI-DI
60889978618897
PMA / PMN Number
K191025
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
TH
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

CARESTREAM HEALTH INC. (CSH) HAS INVESTIGATED THIS ISSUE AND CONCLUSIVE ROOT CAUSE COULD NOT BE DETERMINED BECAUSE INVESTIGATION LOGS COULD NOT BE OBTAINED FROM THE IMPACTED SYSTEM. FROM THE LIMITED INFORMATION AVAILABLE, THE INVESTIGATION TEAM DETERMINED THAT CONNECTORS ON THE CHARGER MONITOR BOARD (CMB) WERE NOT FULLY SEATED AND LATCHED THAT LED TO ARCING BETWEEN CONTACTS. THIS MAY PRODUCE EXCESSIVE HEAT LEADING TO THE THERMAL INCIDENT OBSERVED. CARESTREAM HAS REPAIRED THE CUSTOMER'S SYSTEM AND INITIATED A CORRECTIVE ACTION TO REVIEW AND UPDATE APPLICABLE SERVICING AND MANUFACTURING PROCEDURES TO ENSURE CONNECTORS ARE FULLY SEATED. PER THE PRODUCT SAFETY & PERFORMANCE RISK ASSESSMENT, CARESTREAM'S INVESTIGATION TEAM DETERMINED THAT THE OVERALL PRODUCT SAFETY RISK IS LOW. THE RISK HAS BEEN MITIGATED AS FAR AS POSSIBLE. THERE ARE NO FURTHER CORRECTIVE OR PREVENTIVE ACTIONS TO BE TAKEN BY CARESTREAM HEALTH INC. RELATED TO THIS ISSUE. CARESTREAM HAS COMPLETED THIS INVESTIGATION.

Additional Manufacturer Narrative · 0

ON DECEMBER 13, 2023 AN INITIAL REPORT WAS SUBMITTED AS THERE WERE INSUFFICIENT FACTS AVAILABLE TO MAKE A REPORTABILITY DECISION. SUBMITTING A FOLLOW UP #1 AS INVESTIGATION IS ONGOING. CSH WILL SUBMIT A FOLLOW UP WITH INVESTIGATION UPDATE/FINDINGS WITHIN 30 DAYS.

Additional Manufacturer Narrative · 0

ON DECEMBER 13, 2023 AN INITIAL REPORT WAS SUBMITTED AS THERE WERE INSUFFICIENT FACTS AVAILABLE TO MAKE A REPORTABILITY DECISION. SUBMITTING A FOLLOW UP #2 AS INVESTIGATION IS ONGOING. CSH WILL SUBMIT A FOLLOW UP WITH INVESTIGATION UPDATE/FINDINGS WITHIN 30 DAYS.

Additional Manufacturer Narrative · 0

CSH INVESTIGATION IS CURRENTLY IN PROGRESS. SUBMITTING AN INITIAL REPORT AS THERE ARE CURRENTLY INSUFFICIENT FACTS AVAILABLE TO MAKE A REPORTABILITY DECISION AND AT LEAST 29 DAYS HAS ELAPSED. CSH WILL SUBMIT A FOLLOW UP WITH INVESTIGATION UPDATE/FINDINGS WITHIN 30 DAYS.

Description of Event or Problem · 0

ON 14-NOV-2023, CARESTREAM HEALTH INC. WAS INFORMED OF A THERMAL INCIDENT RELATED TO THE DRX-REVOLUTION SYSTEM. NO INJURIES REPORTED.

Description of Event or Problem · 0

ON 14-NOV-2023, CARESTREAM HEALTH INC. WAS INFORMED OF AN INCIDENT WHERE SMOKE WAS COMING OUT OF THE DRX-REVOLUTION SYSTEM. NO INJURIES REPORTED, THE INVESTIGATION IS ONGOING.

Description of Event or Problem · 0

ON 14-NOV-2023, CARESTREAM HEALTH INC. WAS INFORMED OF AN INCIDENT WHERE SMOKE WAS COMING OUT OF THE DRX-REVOLUTION SYSTEM. NO INJURIES REPORTED, THE INVESTIGATION IS ONGOING.

Description of Event or Problem · 0

ON 14-NOV-2023, CARESTREAM HEALTH INC. WAS INFORMED OF AN INCIDENT WHERE SMOKE WAS COMING OUT OF THE DRX-REVOLUTION SYSTEM. NO INJURIES REPORTED, THE INVESTIGATION IS ONGOING.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2168937 DRX REVOLUTION MOBILE X-RAY SYSTEM DRX REVOLUTION MOBILE X-RAY SYSTEM IZL CARESTREAM HEALTH INC. 60889978618897

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Other