BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    KANG EPMP ADP W/ 4 PWR ADP PLG

    MDR report key: 2963033 · Received January 24, 2013

    Report

    Report Number
    1282497-2013-00001
    Event Type
    Malfunction
    Date Received
    January 24, 2013
    Report Date
    December 31, 2012
    Manufacturer
    COVIDIEN
    Product Code
    LZH
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). AN INVESTIGATION IS CURRENTLY UNDERWAY. UPON COMPLETION, THE RESULTS WILL BE FORWARDED.

    Description of Event or Problem · 1

    IT WAS REPORTED TO COVIDIEN ON (B)(6) 2012 THAT A CUSTOMER HAD AN ISSUE WITH A KANGAROO E-PUMP ADAPTER. THE CUSTOMER REPORTS THAT THE ADAPTER PIECE OF THE POWER CORD THAT ATTACHES TO THE WALL BEGAN SMOKING. THERE IS A SMALL HOLE IN THE ADAPTER WHERE IT BURNED THROUGH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    34871 KANG EPMP ADP W/ 4 PWR ADP PLG POWER CORD LZH COVIDIEN 382491 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK