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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: PHYSIO-CONTROL, INC. - 3015876 LIFEPAK® 20E DEFIBRILLATOR/MONITOR; AUTOMATED EXTERNAL DEFIBRILLATORS (NON-WEARABLE)

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PHYSIO-CONTROL, INC. - 3015876 LIFEPAK® 20E DEFIBRILLATOR/MONITOR; AUTOMATED EXTERNAL DEFIBRILLATORS (NON-WEARABLE) Back to Search Results
Model Number 20E
Medical Device Problem Code Electrical /Electronic Property Problem (1198)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 05/11/2022
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Stryker evaluated the customer's device and was able to verify and duplicate the reported issue.The user interface pcba was replaced to resolve the reported issue.After completing other unrelated repairs, proper device operation was observed through functional and performance testing.The device was returned to the customer for use.
 
Event or Problem Description
The customer contacted stryker to report a non-critical issue with their device.There was no report of patient use associated with the reported event.Upon evaluation of the customer's device, stryker observed that the device logged a critical event that is associated with a device lock up and was intermittently booting up to a white display.A white display can be indicative of a device lock up condition.As a result, defibrillation therapy may be unavailable, if it was needed.
 
Event or Problem Description
The customer contacted stryker to report a non-critical issue with their device.There was no report of patient use associated with the reported event.Upon evaluation of the customer's device, stryker observed that the device logged a critical event that is associated with a device lock up and was intermittently booting up to a white display.A white display can be indicative of a device lock up condition.As a result, defibrillation therapy may be unavailable, if it was needed.
 
Additional Manufacturer Narrative
Stryker further evaluated the device and determined the root cause was corrupt memory on integrated circuit, designator u2.
 
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Brand Name
LIFEPAK® 20E DEFIBRILLATOR/MONITOR
Common Device Name
AUTOMATED EXTERNAL DEFIBRILLATORS (NON-WEARABLE)
Manufacturer (Section D)
PHYSIO-CONTROL, INC. - 3015876
11811 willows road ne
redmond WA 98052
Manufacturer (Section G)
PHYSIO-CONTROL, INC. - 3015876
11811 willows road ne
redmond WA 98052
Manufacturer Contact
todd bandy
11811 willows road ne
redmond, WA 98052
4258674000
MDR Report Key15452096
Report Number0003015876-2022-02095
Device Sequence Number20557225
Product Code MKJ
UDI-Device Identifier00885074515281
UDI-Public00883873813805
Combination Product (Y/N)N
Initial Reporter StateKY
Initial Reporter CountryUS
PMA/510(K) Number
K130454
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source User Facility
Initial Reporter Occupation Non-Healthcare Professional
Type of Report Initial,Followup
Report Date (Section B) 12/06/2022
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? Yes
Operator of Device Health Professional
Device Model Number20E
Device Catalogue Number99507-000010
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer05/25/2022
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 08/25/2022
Supplement Date Received by Manufacturer11/28/2022
Initial Report FDA Received Date09/19/2022
Supplement Report FDA Received Date12/06/2022
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured07/27/2011
Is the Device Labeled for Single Use? (Y/N) No
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Usage of Device Reuse
Patient Sequence Number1
Patient SexUnknown
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