BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACUITY CENTRAL MONITORING

    MDR report key: 2902081 · Received November 29, 2012

    Report

    Report Number
    3023750-2012-00095
    Event Type
    Malfunction
    Date Received
    November 29, 2012
    Date of Event
    November 4, 2012
    Report Date
    November 4, 2012
    Manufacturer
    WELCH ALLYN PROTOCOL, INC.
    Product Code
    DSI
    PMA / PMN Number
    K052160
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    BIOMEDICAL ENGINEER

    Narratives

    Additional Manufacturer Narrative · 1

    THE CUSTOMER CONFIRMED THAT THE DISPLAY FAILED. THE VIEWSONIC DISPLAY IS AN OFF-THE-SHELF COMPUTER PERIPHERAL MADE BY ANOTHER MFR AND SOLD BY WELCH ALLYN. WELCH ALLYN DOES NOT POSSESS TROUBLESHOOTING CAPABILITY BEYOND IDENTIFYING THESE SUBCOMPONENTS AS THE SOURCE OF THE FAILURE. METHOD: (CUSTOMER CONFIRMED DISPLAY FAILURE).

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT THEY LOST THEIR DISPLAY SCREEN. THE CUSTOMER REPLACED IT WITH A SPARE DISPLAY PANEL AND THEY WERE ABLE TO INSTALL THAT. THE CUSTOMER HAS NOT REQUESTED A NEW DISPLAY AT THIS TIME AS THEY HAD A SPARE UNIT ON HAND. THERE WAS NO REPORT OF ANY PT HARM AS A RESULT OF THE REPORTED EVENTS. THE CUSTOMER DID NOT PROVIDE ANY PT INFO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACUITY CENTRAL MONITORING DSI WELCH ALLYN PROTOCOL, INC. DISPLAY, 19", ANA

    Patients

    Seq Age Sex Outcome Treatment
    1