MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,06,07 report with the FDA on 2006-04-18 for INFINITY DOCKING STATION POWER SUPPLY 5206110E546U manufactured by Draeger Medical Systems, Inc..
[442732]
During servicing of the wall connection, the customer reported that infinity docking station power supply exhibited smoke emission after a loud bang occurred. This lead to a light electrical shock into the left arm. No reported injury transpired.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1220063-2006-00014 |
| MDR Report Key | 702362 |
| Report Source | 01,06,07 |
| Date Received | 2006-04-18 |
| Date of Report | 2006-03-20 |
| Date of Event | 2006-03-16 |
| Date Mfgr Received | 2006-03-24 |
| Device Manufacturer Date | 2005-12-01 |
| Date Added to Maude | 2006-04-25 |
| 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 | BIOMEDICAL ENGINEER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | WALTER ADAMSON |
| Manufacturer Street | 16 ELECTRONICS AVENUE |
| Manufacturer City | DANVERS MA 01923 |
| Manufacturer Country | US |
| Manufacturer Postal | 01923 |
| Manufacturer Phone | 9789077500 |
| Manufacturer G1 | DRAEGER MEDICAL SYSTEMS, INC. |
| Manufacturer Street | 16 ELECTRONICS AVENUE |
| Manufacturer City | DANVERS MA 01923 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 01923 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | INFINITY DOCKING STATION POWER SUPPLY |
| Generic Name | DC POWER SUPPLY FOR DOCKING STATION |
| Product Code | MPE |
| Date Received | 2006-04-18 |
| Model Number | 5206110E546U |
| Catalog Number | 5206110E546U |
| Lot Number | NA |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 691491 |
| Manufacturer | DRAEGER MEDICAL SYSTEMS, INC. |
| Manufacturer Address | * DANVERS MA * US |
| Baseline Brand Name | INFINITY DOCKING STATION POWER SUPPLY |
| Baseline Generic Name | DC POWER SUPPLY FOR DOCKING STATION |
| Baseline Model No | 5206110E546U |
| Baseline Catalog No | 5206110E546U |
| Baseline ID | NA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2006-04-18 |