BEUDAMED
    FDA Adverse Event Other Summary report: N

    IMPACT

    MDR report key: 2442901 · Received February 3, 2012

    Report

    Report Number
    2242630-2011-00102
    Event Type
    Other
    Date Received
    February 3, 2012
    Date of Event
    October 1, 2011
    Report Date
    December 10, 2011
    Manufacturer
    IMPACT INSTRUMENTATION, INC.
    Product Code
    BTA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DATE NOTIFIED: (B)(6) 2011. A MODEL 305 PORTABLE ASPIRATOR (SN (B)(4)) FAILED TO OPERATE. AN INSP OF THE DEVICE REVEALED A DEFECTIVE CIRCUIT BREAKER. THE CIRCUIT BREAKER WAS REPLACED, THE DEVICE WAS TESTED TO SPECS AND RETURNED TO THE CUSTOMER. NO DEATH OR INJURY RESULTED FROM THE DEVICE MALFUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPACT PORTABLE ASPIRATOR BTA IMPACT INSTRUMENTATION, INC. 305

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Other