MAUDE Adverse Event Report: LEONHARD LANG GMBH STABLE BASE; ECG ELECTRODE

Model Number	W-601
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Blister (4537)
Date of Event	12/17/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Retained samples of the concerned lot/batch of model sbt601 have been inspected visually.Mechanical tests were performed on 3 retained samples.All tested samples were found to perform within limits.No faults could be detected.We will request further information on the patient, skin type, state of skin, whether any medication was being taken, which might have a skin weakening effect, details of the use and relay any in a follow up report.
Event or Problem Description
On (b)(6) 2023, we have been informed about 26 incidents with ecg electrodes.Monitoring ecg electrodes (model sbw601 and sbt601) had been used with bodyguardian mini+ and bodyguardian one devices.The initial reporter has attached for each patient an incident summary.In total, there were 26 reports covering a period from december 01st - 28th.No medical intervention was necessary for 25 incidents.For 1 incident a medical intervention was needed to treat the injury.The reportable event disclosed that the patient's skin was prepared using soap and water before applying the ecg electrodes.The patient experienced "redness, blisters, bleeding".The ecg electrodes have been removed "while bathing".It was also reported that the patient has worn ecg electrodes for 2 days and had changed them one time.No skin irritation was visible before applying the ecg electrodes.It was stated that a medical intervention was needed to treat the injury and that an ointment was prescribed.No further information was provided.
Additional Manufacturer Narrative
Retained samples of the concerened lot/batch of model sbt601 have been inspected visually.Mechanical tests were performed on 3 retained samples.All tested samples were found to perform within limits.No faults could be detected.We have requested for further information on the patient, skin type, state of skin, whether any medication was being taken, which might have a skin weakening effect, details of the use and have been informed that "no additional information (.)" was available and our distributor has "not received any additional news, comments, or reports (.)." we therefore consider the investigation and the report closed.
Event or Problem Description
On (b)(6) 2023, we have been informed about 26 incidents with ecg electrodes.Monitoring ecg electrodes (model sbw601 and sbt601) had been used with bodyguardian mini+ and bodyguardian one devices.The initial reporter has attached for each patient an incident summary.In total, there were 26 reports covering a period from december 01st - 28th.No medical intervention was necessary for 25 incidents.For 1 incident a medical intervention was needed to treat the injury.The reportable event disclosed that the patient's skin was prepered using soap and water before applying the ecg electrodes.The patient experienced "redness, blisters, bleeding".The ecg electrodes have been removed "while bathing".It was also reported that the patient has worn ecg electrodes for 2 days and had changed them one time.No skin irrititation was visible before applying the ecg electrodes.It was stated that a medical intervention was needed to treat the injury and that an ointment was prescribed.No further information was provided.

• Brand Name: STABLE BASE
• Common Device Name: ECG ELECTRODE
• Manufacturer (Section D): LEONHARD LANG GMBH; archenweg 56; innsbruck, 6020 ; AU 6020
• Manufacturer (Section G): LEONHARD LANG GMBH; archenweg 56; innsbruck, 6020 ; AU 6020
• Manufacturer Contact: bernhard ladner ; archenweg 56; innsbruck, tirol 6020 ; AU 6020
• MDR Report Key: 16500816
• Report Number: 8020045-2023-00005
• Device Sequence Number: 20365735
• Product Code: DRX
• UDI-Device Identifier: 10861779000274
• UDI-Public: (01)10861779000274
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K023503
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 03/20/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Other
• Device Expiration Date: 12/06/2024
• Device Model Number: W-601
• Device Catalogue Number: SBW601
• Device Lot Number: 211206-0259
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/08/2023
• Supplement Date Received by Manufacturer: 02/08/2023
• Initial Report FDA Received Date: 03/08/2023
• Supplement Report FDA Received Date: 03/21/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 12/06/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown