MAUDE MDR 3193180

MDR report key
3193180
Report number
2918630-2013-00001
Event key
0
Event type
3
Date of event
2013-05-28
Date received
2013-06-25
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
JUDY BRIMACOMBE
Address
5160 HACIENDA DR. DUBLIN CA 94568 US
Phone
925-925-9255
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1CIRRUS HD OCTOPHTHALMOSCOPE, AC-POWEREDCARL ZEISS MEDITEC, INC.HLI40000496-090NAY Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12013-06-250

Event Narratives#

D

Patient 1

A HEALTH CARE PROFESSIONAL REPORTED THAT BETWEEN PT EXAMINATIONS WITH THE CIRRUS HD-OCT 4000, HE OBSERVED THAT THE INSTRUMENT WAS EMITTING WHITE SMOKE AND THE DISPLAY SCREEN WAS BLANK. HE IMMEDIATELY UNPLUGGED THE POWER CABLE AND COVERED THE INSTRUMENT WITH A FIRE BLANKET. HE SUBSEQUENTLY REMOVED THE FIRE BLANKET AND FOUND THAT ONE OF THE INSTRUMENT COVERS HAD BEEN DEFORMED AND FLAMES WERE VISIBLE. HE USED A FOAM FIRE EXTINGUISHER TO PUT OUT THE FIRE. IT WAS REPORTED THAT THERE WERE NO INJURIES AND THE FIRE WAS CONFINED TO THE INSTRUMENT.

N

Patient 1

THE DEVICE, WHICH WAS RETURNED TO THE MANUFACTURER, UNDERWENT AN ANALYSIS OF POSSIBLE FAILURE MODES AT A THIRD-PARTY LAB. THE LAB DETERMINED THAT A TANTALUM CAPACITOR FAILED AND DISCHARGED A SMALL EXTREME TEMPERATURE PARTICLE THAT LODGED IN THE INSULATION OF A CABLE. THE INSULATION OF THE CABLE ACTED AS FUEL FOR THE RESULTING FIRE. (B)(4). SITE CONTACT: SAME AS INITIAL REPORTER.