MAUDE MDR 4445130

MDR report key
4445130
Report number
1723686-2014-00003
Event key
0
Event type
3
Date of event
2012-10-01
Date received
2014-08-05
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Address
9990 PARK MEADOWS DR. LONE TREE CO 80124 US
Phone
800-800-8004
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ZYNEXNEXWAVEZYNEX MEDICALIPFY Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-08-0501. O

Event Narratives#

D

Patient 1

THE UNIT SMELLED LIKE IT WAS BURNING AND FELT HOT.

N

Patient 1

REPORTING DUE TO A FDA FINDING DURING AN AUDIT IN 01/2014. NO INJURY TO THE PATIENT. CONCLUSION: THE Q28 COMPONENT WAS THE CAUSE OF THE FAILURE.