MAUDE Adverse Event Report: MEDLINE INDUSTRIES, LP; 2 PCS BED, LOW FULL ELECTRIC, MEDLITE

Catalog Number MDR107003LO

Device Problem Appropriate Term/Code Not Available (3191)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 09/18/2023

Event Type  Injury  

Manufacturer Narrative

According to the facility "there were sparks when plugged directly into the wall, into a power strip, and into an extension cord, and every time it was plugged in it would spark and pop the circuit breaker".Per the facility no one was injured and the customer uses it every day.No additional information is available at this time.The sample was requested for evaluation.It has been determined that the reported event could cause or contribute to serious injury if it were to occur.In an abundance of caution, this medwatch is being filed.If any further relevant information is identified or obtained, a supplemental medwatch will be submitted.

Event Description

According to the facility "there were sparks when plugged directly into the wall, into a power strip, and into an extension cord, and every time it was plugged in it would spark and pop the circuit breaker".

• Type of Device: 2 PCS BED, LOW FULL ELECTRIC, MEDLITE
• Manufacturer (Section D): MEDLINE INDUSTRIES, LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: justin herrmann ; three lakes drive; northfield, IL 60093
• MDR Report Key: 17902244
• MDR Text Key: 325227498
• Report Number: 1417592-2023-00410
• Device Sequence Number: 1
• Product Code: LLI
• UDI-Device Identifier: 40080196325901
• UDI-Public: 40080196325901
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 10/09/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/09/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Catalogue Number: MDR107003LO
• Was Device Available for Evaluation?: Yes
• Date Manufacturer Received: 09/18/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other