BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    5.0 CM SHORT ATTACHMENT

    MDR report key: 3042698 · Received April 2, 2013

    Report

    Report Number
    1045834-2013-01173
    Event Type
    Malfunction
    Date Received
    April 2, 2013
    Date of Event
    August 25, 2011
    Report Date
    August 26, 2011
    Manufacturer
    THE ANSPACH EFFORT, INC.
    Product Code
    HBC
    PMA / PMN Number
    K011444
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE HAS BEEN RECEIVED BY ANSPACH. RELIABILITY ENGINEERING EVALUATED THE DEVICE, AND THE REPORTED HEAT WAS NOT CONFIRMED. THE UNIT MET TEMPERATURE REQUIREMENTS. HOWEVER, THE UNIT WAS OBSERVED TO EXHIBIT EXCESSIVE VIBRATION, LIKELY DUE TO WORN BEARINGS AND THE PRESENCE OF DRIED BIOLOGICAL DEBRIS OBSERVED ON THE BEARINGS AND INTERNAL COMPONENTS. THE NOSE TUBE ALSO EXHIBITED DAMAGE (DENTING) THAT APPEARED TO HAVE BEEN CAUSED BY THE UNIT BEING DROPPED. THIS CONDITION IS INDICATIVE OF IMPROPER OR INEFFECTIVE CLEANING AND HANDLING OF THE EQUIPMENT. IF ADDITIONAL INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SENT. (B)(4).

    Description of Event or Problem · 1

    REPORT RECEIVED FROM THE USA STATING THE DEVICE WAS "OVERHEATING." THE DEVICE WAS BEING USED DURING A PROCEDURE. NO PATIENT OR USER INJURIES WERE REPORTED. THERE WAS NO ADDITIONAL INFORMATION PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    134830 5.0 CM SHORT ATTACHMENT HBC THE ANSPACH EFFORT, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1