BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PORTABLE OXYGEN GENERATOR (CONCENTRATOR, HOMEFILL)

    MDR report key: 2882767 · Received December 20, 2012

    Report

    Report Number
    1031452-2012-00462
    Event Type
    Malfunction
    Date Received
    December 20, 2012
    Report Date
    December 19, 2012
    Manufacturer
    INVACARE FLORIDA OPERATIONS
    Product Code
    CAW
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SN
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4) HAS BEEN INITIATED FOR THIS ISSUE. THE MALFUNCTION HAS NOT BEEN CONFIRMED.

    Description of Event or Problem · 1

    (B)(4). NO SERIOUS INJURY ALLEGED. MALFUNCTION ALLEGED. THE UNIT WAS NOT WORKING AT ALL AND THE DEALER OPENED THE LID OF THE ADAPTER AND FOUND THE PLASTIC COVER MELTED AND THERE WERE BURN MARKS FROM THE INSIDE OF THE DC CAR ADAPTER. MDR FILED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PORTABLE OXYGEN GENERATOR (CONCENTRATOR, HOMEFILL) 868.5440 CAW INVACARE FLORIDA OPERATIONS XPO140

    Patients

    Seq Age Sex Outcome Treatment
    1 Other