MAUDE Adverse Event Report: DJO, LLC CHATTANOOGA THERATHERM MOIST HEAT 14X27STD; PAD, HEATING, POWERED

Model Number	1032
Medical Device Problem Code	Overheating of Device (1437)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	05/12/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The reporter did not indicate that the device will be returned for evaluation.If the manufacturer receives the device, a supplemental report will be submitted upon completion of the evaluation.
Event or Problem Description
It was reported that the device is over heating.There was reportedly no injury and there was no reported patient involvement.

• Brand Name: CHATTANOOGA THERATHERM MOIST HEAT 14X27STD
• Common Device Name: PAD, HEATING, POWERED
• Manufacturer (Section D): DJO, LLC; 1430 decision street; vista CA 92081 9663
• MDR Report Key: 8662584
• Report Number: 2020737-2019-00006
• Device Sequence Number: 16209041
• Product Code: IRT
• UDI-Device Identifier: 00888912000147
• UDI-Public: 00888912000147
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K770686
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 06/03/2019

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: No Information
• Device Model Number: 1032
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/13/2019
• Initial Report FDA Received Date: 06/03/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1