MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 99 report with the FDA on 2013-04-01 for CHATTANOOGA HYDROCOLLATOR manufactured by Djo, Llc.
[3412482]
"received court documents stating that the plaintiff was electrocuted by a hydrocollator while attempting to unplug the product from an electrical outlet. " initial notification of complaint was a copy of court document notification of civil action. No additional info supplied to us for eval. Product not returned to us for eval.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9616086-2013-00002 |
| MDR Report Key | 3032496 |
| Report Source | 99 |
| Date Received | 2013-04-01 |
| Date of Report | 2013-04-01 |
| Date of Event | 2011-08-22 |
| Date Mfgr Received | 2013-03-04 |
| Date Added to Maude | 2013-04-04 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 0 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Street | 1430 DECISION ST. |
| Manufacturer City | VISTA CA 92081 |
| Manufacturer Country | US |
| Manufacturer Postal | 92081 |
| Manufacturer G1 | DJ ORTHOPEDICS DE MEXICO, S.A. DE C.V. |
| Manufacturer Street | 20230 SUBMETROPOLI EL FLORIDO CARRETERA LIBRE TIJUANA TECATE |
| Manufacturer City | TIJUANA 22244 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 22244 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CHATTANOOGA HYDROCOLLATOR |
| Generic Name | HYDROCOLLATOR |
| Product Code | IMA |
| Date Received | 2013-04-01 |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DJO, LLC |
| Manufacturer Address | 1430 DECISION ST. VISTA CA 92081 US 92081 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2013-04-01 |