MAUDE Adverse Event Report: MASIMO - 15750 ALTON PKWY RAD-67 SPOT CHECK PULSE CO-OXIMETER

Model Number 27692

Device Problem High Readings (2459)

Patient Problem Anemia (1706)

Event Date 07/13/2022

Event Type  malfunction  

Event Description

The customer reported inaccurate high sphb values compared to a competitor device and lab results.When the lab test (conducted 2 days post use of the masimo device) indicated the patient's sphb was too low, the hospital decided to admit the patient.The patient received a blood transfusion.

Manufacturer Narrative

Additional manufacturing narrative: attempts have been made to obtain the product.The product has not been returned to masimo to allow an analysis to be performed.If the product is returned for evaluation or new information is obtained, a follow up report will be submitted.

Manufacturer Narrative

Additional manufacuring narrative: other, other text: the monitor involved in this case was not returned for evaluation.The involved sensor was returned and evaluated.During evaluation the sensor passed all visual and functional testing.The sensor passed continuity testing using a tester and also passed accuracy tests.The customer's complaint regarding accuracy was not duplicated.Additional information: h6 event problem and evaluation codes, h10 additional manufacturer narrative h3 other text : device not returned.

Event Description

The customer reported inaccurate high sphb values compared to a competitor device and lab results.When the lab test (conducted 2 days post use of the masimo device) indicated the patient's sphb was too low, the hospital decided to admit the patient.The patient received a blood transfusion.

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.

Event Description

The customer reported inaccurate high sphb values compared to a competitor device and lab results.When the lab test (conducted 2 days post use of the masimo device) indicated the patient's sphb was too low, the hospital decided to admit the patient.The patient received a blood transfusion.

• Brand Name: RAD-67 SPOT CHECK PULSE CO-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: 15214264
• MDR Text Key: 301737553
• Report Number: 3019388613-2022-00182
• Device Sequence Number: 1
• Product Code: DQA
• UDI-Device Identifier: 00843997012812
• UDI-Public: 00843997012812
• Combination Product (y/n): N
• Reporter Country Code: SP
• PMA/PMN Number: K040214
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,User Facility,Company Representative
• Reporter Occupation: Non-Healthcare Professional
• Remedial Action: Other
• Type of Report: Initial,Followup,Followup
• Report Date: 07/19/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/11/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 27692
• Device Catalogue Number: 9794
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 09/15/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 07/27/2021
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Treatment: DCI-MINI SC 400 SENSOR.
• Patient Outcome(s): Hospitalization
• Patient Sex: Male
• Patient Weight: 98 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: White