BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LUMENIS ONE

    MDR report key: 4843136 · Received June 14, 2015

    Report

    Report Number
    3004135191-2015-00036
    Event Type
    Malfunction
    Date Received
    June 14, 2015
    Date of Event
    January 30, 2015
    Report Date
    June 10, 2015
    Manufacturer
    LUMENIS, LTD.
    Product Code
    GEX
    PMA / PMN Number
    K060448
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    LUMENIS INVESTIGATED THE REPORTED COMPLAINT. A LUMENIS TECHNICAL EXPERT COMPLETED AN EXAMINATION OF THE SUBJECT DEVICE IDENTIFYING A CRACK IN A COOLANT TUBE FITTING TO BE THE CAUSE OF THE EVENT REPORT. LUMENIS IS REPORTING THIS COMPLAINT SINCE IT IS SIMILAR TO AN EVENT IN WHICH THE COOLING SYSTEM LEAK RESULTED IN COMBUSTION OF THE HIGH VOLTAGE POWER SUPPLY. THE ORIGINAL MDR WAS MDR 3004135191-2012-00063-(B)(4).

    Description of Event or Problem · 1

    A FOREIGN USER FACILITY REPORTED THAT A COOLING SYSTEM LEAK OCCURRED IN A LUMENIS ONE LASER. NO REPORT OF RELATED INJURY WAS RECEIVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    387063 LUMENIS ONE INTENSE PULSE LIGHT DELIVERY DEVICE GEX LUMENIS, LTD. LUMENIS ONE

    Patients

    Seq Age Sex Outcome Treatment
    1 Other