MAUDE Adverse Event Report: MASIMO - 15750 ALTON PKWY USPO2 OXIMETRY CABLE, GE APEXPRO CH; OXIMETER

Model Number 3449

Device Problem Sensing Intermittently (1558)

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

Event Date 10/01/2022

Event Type  malfunction  

Event Description

The customer reported intermittent connection or not working at all.No patient impact or consequences were reported.

Manufacturer Narrative

Additional manufacturing narrative: attempts have been made to obtain the product.The product has not been returned to masimo to allow an analysis to be performed.If the product is returned for evaluation or new information is obtained, a follow up report will be submitted.Device not returned.

Manufacturer Narrative

Additional manufacuring narrative: other text: the returned device was evaluated.During functional testing, the module intermittently did not draw power or communicate with interfacing test fixture with cable bending at the ch connector.Testing confirmed an electrical open at wire breaks inside ch bend relief.The wire breaks resulted in loss of function.

Event Description

The customer reported intermittent connection or not working at all.No patient impact or consequences were reported.

• Brand Name: USPO2 OXIMETRY CABLE, GE APEXPRO CH
• Type of Device: OXIMETER
• Manufacturer (Section D): MASIMO - 15750 ALTON PKWY; 15750 alton pkwy; irvine CA 92618
• Manufacturer (Section G): MASIMO - MEXICALI; industrial vallera de mexicali calzada del oro, no.2001; mexicali, baja california 21600 ; MX 21600
• Manufacturer Contact: matofa fautua ; 15750 alton pkwy; irvine, CA 92618 ; 9498223661
• MDR Report Key: 15794892
• MDR Text Key: 304204774
• Report Number: 3019388613-2022-00244
• Device Sequence Number: 1
• Product Code: DQA
• UDI-Device Identifier: 00843997011433
• UDI-Public: 00843997011433
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K121914
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility
• Reporter Occupation: Nurse
• Remedial Action: Other
• Type of Report: Initial,Followup
• Report Date: 10/17/2022

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
• Device Operator: Health Professional
• Device Model Number: 3449
• Device Catalogue Number: 3449
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Initial Date Manufacturer Received: 10/17/2022
• Initial Date FDA Received: 11/14/2022
• Supplement Dates Manufacturer Received: 02/28/2023
• Supplement Dates FDA Received: 03/24/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 03/06/2020
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1