MAUDE Adverse Event Report: PRIMUS MEDICAL LLC PRIME CARE TRANSCEND ADVANCED MATTRESS

Model Number TACM3580

Device Problems Break (1069); Fracture (1260); Material Integrity Problem (2978)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 03/31/2015

Event Type  malfunction  

Event Description

Customer received 2nd recall notification and called in stating that they had a mattress that delaminated.

Manufacturer Narrative

This mattress has not been inspected due to the customer discarding of the mattress.A new mattress is being shipped to the customer.This problem was assigned to capa #(b)(4), and a f/u report will be submitted upon completion of the corrective action.

• Brand Name: PRIME CARE TRANSCEND ADVANCED MATTRESS
• Manufacturer (Section D): PRIMUS MEDICAL LLC; boardman OH
• Manufacturer Contact: mark hudson ; 5850 klockner dr.; richmond, VA 23231 ; 8042261155
• MDR Report Key: 4739805
• MDR Text Key: 5887999
• Report Number: 3007538326-2015-00026
• 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: 04/23/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/29/2015
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: No
• Device Operator: Other
• Device Model Number: TACM3580
• Device Catalogue Number: SP02-TACM3580
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 03/31/2015
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• 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