MAUDE Adverse Event Report: JABIL CIRCUIT (SHANGHAI) LTD LATITUDE COMMUNICATOR; EXTERNAL COMMUNICATOR

Model Number	6290
Medical Device Problem Code	Power Problem (3010)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/25/2021
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the communicator power cord melted, and the communicator was not powering up.The patient reported a burning smell.A boston scientific company representative discussed with the patient and opted to replace the entire system.A return label was sent.No adverse patient effects were reported.
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
It was reported that the communicator power cord melted, and the communicator was not powering up.The patient reported a burning smell.A boston scientific company representative discussed with the patient and opted to replace the entire system.No adverse patient effects were reported.The communicator was deactivated.A return label was sent.
Additional Manufacturer Narrative
Upon receipt at our post market quality assurance laboratory additional information from product analysis indicates that the allegation was confirmed.During visual analysis, the communicator adapter had a missing piece, and the power adapter was not snug when plugged in.The communicator was taking apart, and areas were burnt and could smell a smoky, fire smell.Resistance testing on a component was not performed due to the component was being completely burnt.The communicator behavior was consistent with a high-power electrical overstress event.If information is provided in the future, a supplemental report will be issued.

• Brand Name: LATITUDE COMMUNICATOR
• Common Device Name: EXTERNAL COMMUNICATOR
• Manufacturer (Section D): JABIL CIRCUIT (SHANGHAI) LTD; 600 tian lin rd; shanghai ; CH
• Manufacturer Contact: timothy degroot ; 4100 hamline avenue north; saint paul, MN 55112 ; 6515826168
• MDR Report Key: 14595219
• Report Number: 2124215-2022-13555
• Device Sequence Number: 14816046
• Product Code: LWS
• UDI-Device Identifier: 00802526544224
• UDI-Public: 00802526544224
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: P910077/S140
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 01/25/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Lay User/Patient
• Device Model Number: 6290
• Device Catalogue Number: 6290
• Device Lot Number: 5258125
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 04/17/2022
• Supplement Date Received by Manufacturer: 12/26/2022
• Initial Report FDA Received Date: 06/03/2022
• Supplement Report FDA Received Date: 01/25/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Age: 30 YR
• Patient Sex: Female