FDA Adverse Event Malfunction Summary report: N

MAINFRAME 8252001IP RESPONSE 2.0 W/INCRE

MDR report key: 2897724 · Received January 4, 2013

Report

Report Number
1045254-2013-00015
Event Type
Malfunction
Date Received
January 4, 2013
Report Date
December 6, 2012
Manufacturer
XOMED MFG JACKSONVILLE
Product Code
ETN
PMA / PMN Number
K024316
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NY, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

PRODUCT ANALYSIS WAS COMPLETED. THE UNITS WERE EVALUATED AND FOUND THE CPU BATTERY REQUIRED REPLACEMENT. THE STIMULATION CONTROL BOARD WAS BAD AND REQUIRED REPLACEMENT. BOTH COMPONENTS RECEIVED PREVENTATIVE MAINTENANCE AND WERE TESTED TO SPECIFICATION, AND RETURNED TO THE CUSTOMER. THE COMPLAINT WAS CONFIRMED AND FOUND TO BE OUT OF SPECIFICATION.

Additional Manufacturer Narrative · 1

THIS PRODUCT IS USED FOR THERAPEUTIC PURPOSES. (B)(4). THE PRODUCT HAS NOT YET BEEN RETURNED TO THE MANUFACTURER FOR EVALUATION. EVALUATION, METHOD: NO TESTING METHODS PERFORMED. EVALUATION, RESULT : NO RESULTS AVAILABLE SINCE NO EVALUATION PERFORMED. CONCLUSION - DEVICE NOT RETURNED - NO EVALUATION WILL BE PERFORMED.

Additional Manufacturer Narrative · 1

PRODUCT WAS RETURNED FOR ANALYSIS ON (B)(4) 2012. PRODUCT # 8252800, INTERFACE RESPONSE 2.0 INCREMENT WAS ALSO RETURNED FOR EVALUATION. ANALYSIS FOUND A BLOWN FUSE.

Additional Manufacturer Narrative · 1

IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

Description of Event or Problem · 1

IT WAS REPORTED THAT THERE WAS NO STIM RETURN. THERE WAS NO REPORTED PATIENT IMPACT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
5386 MAINFRAME 8252001IP RESPONSE 2.0 W/INCRE STIMULATOR, NERVE ETN XOMED MFG JACKSONVILLE 8252001IP 59899800

Patients

Seq Age Sex Outcome Treatment
1