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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 01/24/2024
Type of Reportable Event Malfunction
Event or Problem Description
The customer contacted stryker to report that their device displayed a white screen and locked up during boot up.This is an indication that the device would be inoperable and defibrillation therapy would not be available if needed.There was no patient use associated with the reported event.
 
Additional Manufacturer Narrative
Stryker evaluated the customer¿s device and verified the reported issue.Stryker replaced the system controller pcb and the user interface pcb assemblies.Thereafter proper device operation was observed through functional and performance testing and the device was returned to the customer for use.
 
Additional Manufacturer Narrative
Stryker further evaluated the removed user interface pcb assembly and determined that the cause of the reported issue was due to capacitor, designator c181.C181 was cracked and electrically shorted.
 
Event or Problem Description
The customer contacted stryker to report that their device displayed a white screen and locked up during boot up.This is an indication that the device would be inoperable and defibrillation therapy would not be available if needed.There was no patient use associated with the reported event.
 
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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
brian blakeslee
11811 willows road ne
redmond, WA 98052
4258674000
MDR Report Key18693854
Report Number0003015876-2024-00311
Device Sequence Number7271965
Product Code MKJ
UDI-Device Identifier00883873852798
UDI-Public00883873852798
Combination Product (Y/N)N
Initial Reporter StateIL
Initial Reporter CountryUS
PMA/510(K) Number
P160026
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) 04/09/2024
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 Number20E
Device Catalogue Number99507-000133
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer01/26/2024
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 01/24/2024
Supplement Date Received by Manufacturer04/08/2024
Initial Report FDA Received Date02/13/2024
Supplement Report FDA Received Date04/09/2024
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured03/02/2020
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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