FDA Adverse Event
Malfunction
Summary report: N
TEMP PUMP
MDR report key: 1983320
·
Received February 4, 2011
Report
- Report Number
- 1313850-2011-00003
- Event Type
- Malfunction
- Date Received
- February 4, 2011
- Date of Event
- December 15, 2010
- Report Date
- January 11, 2011
- Manufacturer
- GAYMAR INDUSTRIES, INC.
- Product Code
- ILO
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- AL, US
- Reporter Occupation
- NOT APPLICABLE
Narratives
Additional Manufacturer Narrative · 1
THE DEVICE HAS NOT BEEN RETURNED FOR INVESTIGATION. NO CONCLUSION CAN BE DRAWN.
Description of Event or Problem · 1
IT WAS REPORTED THAT THE PLUG END OF THE DEVICE'S POWER CORD SHORT CIRCUITED, MELTED AND CREATED A SMALL FIRE AT THE RECEPTACLE THAT THE DEVICE WAS PLUGGED INTO.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | TEMP PUMP | ILO | GAYMAR INDUSTRIES, INC. | 64N07500 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |