BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    KANGAROO EPUMP - NEW

    MDR report key: 1945296 · Received December 21, 2010

    Report

    Report Number
    1310379-2010-00026
    Event Type
    Malfunction
    Date Received
    December 21, 2010
    Report Date
    December 15, 2010
    Manufacturer
    COVIDIEN
    Product Code
    LZH
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, US
    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 THAT A CUSTOMER HAD AN ISSUE WITH A FEEDING PUMP POWER ADAPTER. THE CUSTOMER REPORTS THE AC/DC POWER ADAPTER WHICH CAME WITH THE PUMP CAUGHT ON FIRE. THE CUSTOMER STATED, IT BURNED ON THE END WHICH GOES INTO THE WALL, NOT INTO THE PUMP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KANGAROO EPUMP - NEW POWER ADAPTER LZH COVIDIEN 382400 C0626280

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK