BEUDAMED
    FDA Adverse Event Other Summary report: N

    KCI VAC ULTA POWER CORD

    MDR report key: 6156199 · Received December 6, 2016

    Report

    Report Number
    MW5066587
    Event Type
    Other
    Date Received
    December 6, 2016
    Manufacturer
    ELPAC/KCI
    Product Code
    OMP
    Report Source
    Voluntary report
    Reporter Location
    VA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    ELPAC POWER SUPPLY FOR KCI VAC ULTA MODEL (ELPAC MODEL MWA065015A) CAUGHT FIRE AT THE INTERFACE OF THE CORD TO TRANSFORMER WHILE IN USE ON A PATIENT. KCI VAC ULTA APPLIED (B)(6) 2016 THE DEVICE THAT CAUGHT FIRE WAS REMOVED FROM SERVICE ON (B)(6) 2016 RIGHT AFTER EXTINGUISHING THE FLAMES; ANOTHER DEVICE WAS APPLIED WITH NO ISSUES AFTER THAT POINT. DATES OF USE: (B)(6) 2016. EVENT ABATED AFTER USE STOPPED OR DOSE REDUCED: YES. KCI VAC ULTA APPLIED (B)(6) 2016 THE DEVICE THAT CAUGHT FIRE WAS REMOVED FROM SERVICE ON (B)(6) 2016 RIGHT AFTER EXTINGUISHING THE FLAMES; ANOTHER DEVICE WAS APPLIED WITH NO ISSUES AFTER THAT POINT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    798511 KCI VAC ULTA POWER CORD TRANSFORMER FOR WOUND VAC OMP ELPAC/KCI MWA065015A

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR