MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,consum report with the FDA on 2017-06-12 for OMORN MAX POWER RELIEF PM3032 manufactured by Omron (dalian) Co., Ltd. (plant 2).
[77419172]
(b)(4). Consumer was advised to stop using the unit. A postage paid label was sent to retrieve the unit for further investigation and verbal request for unit return was made. The u. S importer is requesting manufacture of the device to further investigate this incident. A root cause has not been determined. It has not been confirmed if the device caused or contributed to the reported incident. However, due to the customer stating that her doctor had recommended skin graft, this medwatch is being filed.
Patient Sequence No: 1, Text Type: N, H10
[77419173]
Consumer reported the unit has burned her back. She has blisters on her lower back from the pad. This is her first time using the unit. She was placing the pads on her lower back only. She only let the unit run for the 15 minutes. She is using the batteries that came with the unit. She did not add any lotion or perfumes before placing the pads on her back. Consumer stated one pad that was not giving any stimulation is the one that burnt the back. She had not sought medical treatment. She has not added any ointment to the area. She does not see any damage to the cords. She had the intensity up to a 6. Consumer was advised to stop using the unit and was sent the postage paid label to retrieve the unit for further investigation. During follow-up call with quality analyst, the consumer stated the unit is brand new and she is the only user and only used the unit one time, this morning. She has used the tens therapy before at rehab so she knows what to expect with it. She turned the unit on at level 6 intensity. She could feel the stimulation only on one of the pads. When she took the pads off and she had a dark red burn the shape of the pad (the pad that she did not feel the stimulation on). She also has 2 blisters where the pad took off her skin. She used the unit on her lower back. She would send the pictures of the burn. Her back was dry and free from lotion or oils. She wants a refund and not a replacement. Consumer did not indicate any medical treatment or intervention as a result of the event. Consumer was provided with instructions for sending the unit for inspection (further investigation). Consumer stated she will return the unit back for inspection. Consumer sent the pictures of the burn to quality analyst. Quality analyst had noted that aspercreme was purchased at the same time the unit was purchased on 05/24/2017. Another follow-up call was made with consumer to obtain additional information. Consumer confirmed that she did not use aspercreme or any other lotions and her skin was dry before she used the tens unit. Consumer indicated she has the artificial heart valve (which is made of carbon and not metallic or electronic). She did read the instructions manual prior to using the machine. She has the pre-existing conditions of heart issue and had hemorrhagic brain bleed and has back issues. She is on coumadin and monitors her inr at home. Consumer was upset and stated it and only thing we are doing refunding the money and hung up the phone. Consumer had sent a second email on 05/25/2017 with pictures and wrote that this is how the burn is tonight. It is very painful; i will try and get treatment tomorrow if i can walk with the original back problem still ongoing. Another email from consumer was received on 05/30/2017 with pictures and wrote following: this is a follow up photo of what your product did to my back. You can distinctly see the pattern of the pad on my skin. I am able to drive enough to get to my doctor today, and i am contacting my lawyer concerning your products failure. On 06/05/2017, then the consumer called and spoke to executive director qa/ra. Consumer stated the burns have started to heal. The burns got worse before they got better. She went to doctor last wednesday ((b)(6) 2017). Consumer stated her doctor has recommended a skin graft. She has contacted lawyer. She was disappointed that there was no follow up. The consumer stated the burns are healing and consumer did not state she has received a skin graft it was only a recommendation by her doctor.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3003263296-2017-00001 |
| MDR Report Key | 6635587 |
| Report Source | COMPANY REPRESENTATIVE,CONSUM |
| Date Received | 2017-06-12 |
| Date of Report | 2017-08-01 |
| Date of Event | 2017-05-25 |
| Date Facility Aware | 2017-07-10 |
| Date Mfgr Received | 2017-07-10 |
| Device Manufacturer Date | 2016-07-05 |
| Date Added to Maude | 2017-06-12 |
| 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 |
| Reporter Occupation | PATIENT |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. RENEE THORNBOROUGH |
| Manufacturer Street | 1925 W FIELD COURT SUITE 100 |
| Manufacturer City | LAKE FOREST IL 600454824 |
| Manufacturer Country | US |
| Manufacturer Postal | 600454824 |
| Manufacturer Phone | 8472475626 |
| Manufacturer G1 | OMRON (DALIAN) CO., LTD. (PLANT 2) |
| Manufacturer Street | NO. 28 DONGBEI ER STREET, ECO- NOMIC & TECHNICAL DEVELOPMENT |
| Manufacturer City | DALIAN, 116600 |
| Manufacturer Country | CH |
| Manufacturer Postal Code | 116600 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | OMORN MAX POWER RELIEF |
| Generic Name | TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR T.E.N.S., |
| Product Code | NUH |
| Date Received | 2017-06-12 |
| Model Number | PM3032 |
| Catalog Number | PM3032 |
| Lot Number | 20160705016UF |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | 10 MO |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | OMRON (DALIAN) CO., LTD. (PLANT 2) |
| Manufacturer Address | NO. 28 DONGBEI ER STREET, ECO- NOMIC & TECHNICAL DEVELOPMENT DALIAN, 116600 CH 116600 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2017-06-12 |