MAUDE Adverse Event Report: DJO LLC CHATTANOOGA; INTELECT TRANSPORT COMBO PKG US STD

Catalog Number	2738
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Burn(s) (1757)
Date of Event	07/17/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that patient sustained dermal burns during combo modality, no error message received on the device.
Additional Manufacturer Narrative
It was reported that patient sustained dermal burns during combo modality, no error message received on the device.The patients burn was dressed and wand was cleaned at the time the injury occurred.The device has not been returned for evaluation, the root cause could not be established.If more information becomes available additional reporting on this event will be provided as a supplemental report to this document.
Additional Manufacturer Narrative
See d9, h3, h6, and h11.The device has been evaluated by a technician, the device was tested several times with enovis lead wires.The devise was calibrated and tested the applicator several times.There were no issues discovered during the testing process.The customer did not send in their electrodes.The root cause could not be established.Additional reporting on this event will be provided as a supplemental report to this document if more information becomes available.

• Brand Name: CHATTANOOGA
• Common Device Name: INTELECT TRANSPORT COMBO PKG US STD
• Manufacturer (Section D): DJO LLC; 5919 sea otter place; ste 200; carlsbad CA 92010
• Manufacturer (Section G): DJ ORTHOPEDICS DE MEXICO, S.A. DE C.V.; carretera lobre tijuana tecate; 20230 parque industrial el flo; tijuana, b.c. 22245, mex 22245 ; MX 22245
• Manufacturer Contact: jim pomeroy ; 5919 sea otter place; ste 200; carlsbad, CA 92010
• MDR Report Key: 22812228
• Report Number: 9616086-2025-00057
• Device Sequence Number: 12676767
• Product Code: IMG
• UDI-Device Identifier: 00888912021883
• UDI-Public: 00888912021883
• Combination Product (Y/N): N
• Initial Reporter State: CO
• Initial Reporter Country: US
• PMA/510(K) Number: K040285
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 10/01/2025

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
• Operator of Device: Health Professional
• Device Catalogue Number: 2738
• Device Lot Number: T8952
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/17/2025
• Supplement Date Received by Manufacturer: 09/15/2025
• Initial Report FDA Received Date: 08/14/2025
• Supplement Report FDA Received Date: 10/01/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: 27383 LOT: T47788.
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Male