MAUDE Adverse Event Report: PRIMUS MEDICAL, LLC. PRIME CARE (R) TRANSCEND PERIMETER MATTRESS

Model Number TACM3580

Device Problems Nonstandard Device (1420); Delamination (2904)

Patient Problem No Information (3190)

Event Date 09/23/2014

Event Type  malfunction  

Event Description

Upon receipt of the recall packet, the customer notified the firm they had a delaminated mattress.

Manufacturer Narrative

Upon review of the pictures sent from the customer, the urethane cover bubbled at the center and foot section of the mattress, exposing the inside of the top cover of the mattress, a new mattress was shipped to the facility on (b)(6) 2014.This problem has been assigned to capa #(b)(4), and a follow-up report will be submitted upon completion of the corrective action.

• Brand Name: PRIME CARE (R) TRANSCEND PERIMETER MATTRESS
• Manufacturer (Section D): PRIMUS MEDICAL, LLC.; boardman OH
• Manufacturer Contact: mark hudson ; 5850 klockner dr.; richmond, VA 23231 ; 8042261155
• MDR Report Key: 4196974
• MDR Text Key: 17991163
• Report Number: 3007538326-2014-00133
• Device Sequence Number: 1
• Product Code: IKY
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: User Facility
• Reporter Occupation: Other
• Remedial Action: Recall
• Type of Report: Initial
• Report Date: 10/16/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/21/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Other
• Device Model Number: TACM3580
• Device Catalogue Number: SP03-TACM3580
• Device Lot Number: 61312
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 09/23/2014
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 06/13/2012
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Removal/Correction Number: Z-2596-2014
• Patient Sequence Number: 1