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 02/12/2015

Event Type  malfunction  

Event Description

Customer sent an email saying that they had a mattress that is delaminated.

Manufacturer Narrative

Upon review of the pictures sent from the customer the entire urethane cover bubbled up but did not expose the inside of the mattress cover or foam.A new mattress was shipped out to the customer on (b)(4) 2015.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 TRANSCEND ADVANCED MATTRESS
• Manufacturer (Section D): PRIMUS MEDICAL, LLC; boardman OH
• Manufacturer Contact: mark hudson ; 5850 klockner dr; richmod, VA 23231 ; 8042261155
• MDR Report Key: 4602787
• MDR Text Key: 5465140
• Report Number: 3007538326-2015-00009
• Device Sequence Number: 1
• Product Code: IKY
• Combination Product (y/n): N
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Distributor
• Reporter Occupation: Other
• Remedial Action: Recall
• Type of Report: Initial
• Report Date: 03/05/2015

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?: No
• Device Operator: Other
• Device Model Number: TACM3580
• Device Catalogue Number: SP03-TACM3580
• Device Lot Number: 061312
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 02/12/2015
• Initial Date FDA Received: 03/09/2015
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 06/01/2012
• 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