FDA Adverse Event Malfunction Summary report: N

HUT EXT DR FINAL ASSY - STANDARD

MDR report key: 2447143 · Received January 31, 2012

Report

Report Number
1518293-2012-00014
Event Type
Malfunction
Date Received
January 31, 2012
Date of Event
January 12, 2012
Report Date
January 31, 2012
Manufacturer
LIEBEL-FLARSHEIM CO
Product Code
KQS
PMA / PMN Number
EXEMPT
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TN, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

FIELD SERVICE ENGINEER (FSE) INVESTIGATED AND FOUND THE GENERATOR CONSOLE WAS FAILING AT POWER UP AND REPLACED THE CONSOLE. FSE VERIFIED PROPER OPERATION PER MFRS SPEC USING SEDECAL GENERATOR SERVICE MANUAL AND HUT SERVICE CHECKLIST. UNIT PASSED CHECKOUT PROCEDURES AND WAS RETURNED TO FULL SERVICE.

Description of Event or Problem · 1

IN (B)(6), CUSTOMER REPORTED VIA PHONE THAT A GENERATOR CONSOLE FAILURE OCCURRED DURING AN UNK PROCEDURE ON A FEMALE PT. PHYSICIAN COMPLETED THE PROCEDURE. NO INJURIES TO REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 HUT EXT DR FINAL ASSY - STANDARD KQS LIEBEL-FLARSHEIM CO HUT EXT DR NA

Patients

Seq Age Sex Outcome Treatment
1 UNK