GLIDER CART 31113.701

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2015-08-10 for GLIDER CART 31113.701 manufactured by Omni.

Event Text Entries

[22946947] Facility notified (b)(4) when the switch on the side tower was turned on it made a crackling sound and seemed to spark. Cart was turned off and unplugged twice before attempting to turn on the same thing happened two more times. Doctor then pushed each cords ends and jostled them around. This time when switch turned on the equipment on the cart started up. No injuries to a patient or staff member was reported. Device in question is "drop shipped", meaning it is delivered from the manufacturer to the customer without stopping at the importer facility (b)(4) for any testing, inspection or re-labeling. An investigation will not be performed by (b)(4) as device in questioned is manufactured by omni corporation. A request for additional information has been submitted to facility, no response as of 08/10/2015. (b)(4) considers this matter closed. However, in the event we receive additional information, we will provide manufacturer with follow-up information. An investigation will not be performed by (b)(4) as device in questioned is manufactured by omni corporation. A request for additional information has been submitted to facility, no response as of 08/10/2015. A request for additional information has been submitted to facility, no response as of 08/10/2015. (b)(4) considers this matter closed. However, in the event we receive additional information, we will provide manufacturer with follow-up information.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1418479-2015-00025
MDR Report Key4992264
Date Received2015-08-10
Date of Report2015-07-16
Date Facility Aware2015-07-16
Report Date2015-08-10
Date Reported to FDA2015-08-10
Date Reported to Mfgr2015-08-10
Date Added to Maude2015-08-11
Event Key0
Report Source CodeDistributor report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer Street353 CORPORATE WOODS PKWY.
Manufacturer CityVERNON HILLS IL 60061
Manufacturer CountryUS
Manufacturer Postal60061
Manufacturer G1RICHARD WOLF MEDICAL INSTRUMENTS CORP.
Manufacturer Street353 CORPORATE WOODS PKWY.
Manufacturer CityVERNON HILLS IL 60061
Manufacturer CountryUS
Manufacturer Postal Code60061
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameGLIDER CART
Generic NameCART
Product CodeBZN
Date Received2015-08-10
Model Number31113.701
Catalog Number31113.701
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Age3 YR
Device Eval'ed by MfgrI
Device Sequence No1
Device Event Key0
ManufacturerOMNI
Manufacturer AddressDETROIT MI US


Patients

Patient NumberTreatmentOutcomeDate
10 2015-08-10

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