MAUDE Adverse Event Report: MASIMO - 15750 ALTON PKWY RAD-5 PULSE OXIMETER

Model Number 26915

Device Problems Incorrect, Inadequate or Imprecise Result or Readings (1535); Sensing Intermittently (1558)

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

Event Date 07/18/2023

Event Type  malfunction  

Manufacturer Narrative

Additional manufacuring narrative: other, other text: the device has not been returned to the investigation facility to allow for an analysis to be performed.If the product is received for evaluation or new information is obtained, a follow up report will be submitted.

Event Description

The customer reported the rad-5 was "not reading spo2 correctly" and "bpm [was] not accurate".Additionally, a "dropout with limited motion" was observed.No patient impact or consequences were reported.

Event Description

The customer reported the rad-5 was "not reading spo2 correctly" and "bpm [was] not accurate." additionally, a "dropout with limited motion" was observed.There were no patient impact or consequences reported.

Manufacturer Narrative

Additional manufacuring narrative: the returned device was evaluated.During evaluation the device passed all visual and functional testing.During simulation testing, the device passed manual and preset conditions and provided accurate measurements.The unit was found to visually and audibly alarm during alarm conditions.The unit was determined to be functioning as designed.

• Brand Name: RAD-5 PULSE OXIMETER
• 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: tahereh sedighi ; 15750 alton pkwy; irvine, CA 92618 ; 9492977862
• MDR Report Key: 17559134
• MDR Text Key: 321636710
• Report Number: 3019388613-2023-00199
• Device Sequence Number: 1
• Product Code: DQA
• UDI-Device Identifier: 00843997005913
• UDI-Public: 00843997005913
• Combination Product (y/n): N
• Reporter Country Code: AS
• PMA/PMN Number: K033296
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Company Representative,Distributor
• Reporter Occupation: Biomedical Engineer
• Remedial Action: Other
• Type of Report: Initial,Followup
• Report Date: 07/21/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/16/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 26915
• Device Catalogue Number: 9214
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 10/03/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 09/06/2020
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1