BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AC POWER MODULE

    MDR report key: 1961236 · Received December 21, 2010

    Report

    Report Number
    1218950-2010-02685
    Event Type
    Malfunction
    Date Received
    December 21, 2010
    Report Date
    November 30, 2010
    Manufacturer
    PHILIPS HEALTHCARE
    Product Code
    MKJ
    PMA / PMN Number
    K031187
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4): THE CUSTOMER REPORTED TO PHILIPS THAT THE AC POWER MODULE FAILED AND THAT THE AC INLET WAS PULLED OUT. THE AC POWER MODULE WAS REPLACED WHICH RESOLVED THE FAILURE. AS OF 12/13/2010, THERE HAVE BEEN NO FURTHER REPORTS OF THIS ISSUE FROM THIS CUSTOMER SITE.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED TO PHILIPS THAT THE AC POWER MODULE FAILED AND THAT THE AC INLET WAS PULLED OUT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AC POWER MODULE MKJ PHILIPS HEALTHCARE M3539A

    Patients

    Seq Age Sex Outcome Treatment
    1