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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDIVANCE, INC. ¿ 1725056 ARCTIC SUN® TEMPERATURE MANAGEMENT SYSTEM, TEMPERATURE CABLE NELLCOR

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MEDIVANCE, INC. ¿ 1725056 ARCTIC SUN® TEMPERATURE MANAGEMENT SYSTEM, TEMPERATURE CABLE NELLCOR Back to Search Results
Catalog Number 735-02
Device Problems Failure to Sense (1559); Device Sensing Problem (2917)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 02/21/2024
Event Type  malfunction  
Manufacturer Narrative
The investigation is still in progress.Once the investigation is complete a supplemental report will be filed.H11: section a through f - the information provided by bd represents all the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.
 
Event Description
It was reported that the arctic sun device did not detect the temperature probe.Per review of wo on (b)(6) 2024, device was used on patient and no patient injury was detected.Per follow up information received via email on (b)(6) 2024, the device would be repaired onsite by changing the nelcor 73502 cable.The issue was not resolved yet.
 
Manufacturer Narrative
The reported issue was confirmed.The root cause of the reported issue is a failed temperature in cable.The device was evaluated upon receipt.The device was working but the temperature cable in nellcor was the problem because it was broken.The temperature cable in nellcor was not working correctly.Replaced temperature cable.A dhr review is not required as the serial number is unknown.The reported issue was confirmed through other elements of the investigation to not be labeling or packaging related.H11: section a through f - the information provided by bd represents all the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.H3 other text : the actual/suspected device was inspected.
 
Event Description
It was reported that the arctic sun device did not detect the temperature probe.Per review of wo on 23feb2024, device was used on patient and no patient injury was detected.Per follow up information received via email on 23feb2024, the device would be repaired onsite by changing the nelcor 73502 cable.The issue was not resolved yet.Per sample evaluation results on 06mar2024, it was reported that the fill tube was not working correctly.
 
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Brand Name
ARCTIC SUN® TEMPERATURE MANAGEMENT SYSTEM, TEMPERATURE CABLE NELLCOR
Type of Device
TEMPERATURE CABLE NELLCOR
Manufacturer (Section D)
MEDIVANCE, INC. ¿ 1725056
321 s taylor ave
suite 200
louisville 80027
Manufacturer (Section G)
MEDIVANCE, INC. ¿ 1725056
321 s taylor ave
suite 200
louisville 80027
Manufacturer Contact
xeeroy rada
8195 industrial blvd
covington 30014
7707846100
MDR Report Key18837128
MDR Text Key336915463
Report Number1018233-2024-01139
Device Sequence Number1
Product Code DWJ
UDI-Device Identifier00801741080296
UDI-Public(01)00801741080296
Combination Product (y/n)N
Reporter Country CodeSP
PMA/PMN Number
K161602
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Other,Health Professional,User Facility
Reporter Occupation Physician
Type of Report Initial,Followup
Report Date 03/08/2024
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received03/05/2024
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Catalogue Number735-02
Was Device Available for Evaluation? Device Returned to Manufacturer
Is the Reporter a Health Professional? Yes
Date Manufacturer Received03/06/2024
Was Device Evaluated by Manufacturer? Yes
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Reuse
Patient Sequence Number1
Patient Outcome(s) Other;
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