BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BROTHER PRINTER

    MDR report key: 434040 · Received December 20, 2002

    Report

    Report Number
    1823260-2002-00403
    Event Type
    Injury
    Date Received
    December 20, 2002
    Date of Event
    June 11, 2002
    Report Date
    June 11, 2002
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LOQ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WV, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE CUSTOMER NOTICED A PAPER JAM ON THE PRINTER AND WENT TO REMOVE THE PAPER AND GOT SHOCKED. WENT TO THE E.R. AND SHOWED SIGNS OF ELECTRICAL SHOCK. THEY WERE LATER RELEASED. THAT EVENING, THEY EXPERIENCED TACHYCARDIA AND NUMBNESS AND RETURNED TO THE E.R. WHERE THEY WERE EXAMINED AND RELEASED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BROTHER PRINTER ACCESSORY FOR HEMATOLOGY DEVICE LOQ ROCHE DIAGNOSTICS NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other