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

Model Number	20E
Medical Device Problem Code	Failure to Power Up (1476)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/16/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Stryker requested additional information regarding sn of the device.Stryker continues to investigate the reported issue and will submit a supplemental report on this event to the fda as provided by 21 cfr 803.56.
Event or Problem Description
The customer contacted stryker to report that their device would not power on.In this state, the device may not be able to provide defibrillation therapy, if needed.There was no report of patient use associated with the reported event.
Additional Manufacturer Narrative
A stryker service representative performed an initial evaluation of the customer¿s device and was able to duplicate the reported issue.After replacing power module and power supply, proper device operation was observed through functional and performance testing.The device was subsequently returned to the customer.The cause of the reported issue was determined to be due to faulty power module.
Event or Problem Description
The customer contacted stryker to report that their device would not power on.In this state, the device may not be able to provide defibrillation therapy, if needed.There was no report of patient use associated with the reported event.
Event or Problem Description
The customer contacted stryker to report that their device would not power on.In this state, the device may not be able to provide defibrillation therapy, if needed.There was no report of patient use associated with the reported event.
Additional Manufacturer Narrative
Section d4 catalog # of this mdr indicates: 99507-000132.Section d4 catalog # of this mdr should indicate: 99507-000122.Section d4 serial # of this mdr indicates: blank.Section d4 serial # of this mdr should indicate: (b)(6).Sn of the device is updated.Stryker continues to investigate the reported issue and will submit a supplemental report on this event to the fda as provided by 21 cfr 803.56.
Additional Manufacturer Narrative
Corrected data: section d4 gtin of the initial medwatch report indicates: blank.Section d4 gtin of the initial medwatch report should have indicated: (b)(4).
Event or Problem Description
The customer contacted stryker to report that their device would not power on.In this state, the device may not be able to provide defibrillation therapy, if needed.There was no report of patient use associated with the reported event.

• Brand Name: LIFEPAK(R) 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: brian blakeslee ; 11811 willows road ne; redmond, WA 98052 ; 4258674000
• MDR Report Key: 18110295
• Report Number: 0003015876-2023-02086
• Device Sequence Number: 8051417
• Product Code: MKJ
• UDI-Device Identifier: 00883873853863
• UDI-Public: 00883873853863
• Combination Product (Y/N): N
• Initial Reporter State: NC
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 10/16/2024

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 Number: 20E
• Device Catalogue Number: 99507-000122
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 10/16/2023
• Supplement Date Received by Manufacturer: 12/15/2023; 12/19/2023; 09/30/2024
• Initial Report FDA Received Date: 11/10/2023
• Supplement Report FDA Received Date: 12/18/2023; 01/11/2024; 10/16/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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 Number: 1
• Patient Sex: Unknown