MAUDE Adverse Event Report: DIGNITNANA INC DIGNICAP DELTA; SCALP COOOLING

Model Number	900-1001
Medical Device Problem Code	Use of Device Problem (1670)
Health Effect - Clinical Code	Burn(s) (1757)
Date of Event	02/27/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported burn on temple region.Small spot.

• Brand Name: DIGNICAP DELTA
• Common Device Name: SCALP COOOLING
• Manufacturer (Section D): DIGNITNANA INC; 10925 estate lane, w185; dallas TX 75230
• Manufacturer Contact: crista cody ; 10925 estate lane w185; dallas, TX 75238 ; 4699175555
• MDR Report Key: 21591954
• Report Number: 3012146457-2025-00001
• Device Sequence Number: 8266106
• Product Code: PMC
• UDI-Device Identifier: 00850036106005
• UDI-Public: (01)00850036106005(240)900-1001(11)230626
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K19111466
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial
• Report Date (Section B): 03/13/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Model Number: 900-1001
• Device Catalogue Number: 900-1001
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/27/2025
• Initial Report FDA Received Date: 03/13/2025
• Date Device Manufactured: 06/26/2023
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Female