BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    KANG EPMP ADP W/ 4 PWR ADP PLG

    MDR report key: 1902809 · Received November 11, 2010

    Report

    Report Number
    1310379-2010-00022
    Event Type
    Malfunction
    Date Received
    November 11, 2010
    Report Date
    October 22, 2010
    Manufacturer
    COVIDIEN
    Product Code
    LZH
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). AN INVESTIGATION IS CURRENTLY UNDERWAY, UPON COMPLETION THE RESULTS WILL BE FORWARDED.

    Description of Event or Problem · 1

    IT WAS REPORTED TO COVIDIEN ON (B)(6) 2010 THAT A CUSTOMER HAD AN ISSUE WITH A POWER ADAPTER. THE CUSTOMER REPORTS THAT THE ADAPTER HAS SIGNS OF ELECTRICAL ARCING AT THE PINS, PINS ARE SCORED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KANG EPMP ADP W/ 4 PWR ADP PLG POWER ADAPTER LZH COVIDIEN 382491 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK