MAUDE Adverse Event Report: SMITHS MEDICAL ASD, INC. BCI MONITOR HAND HELD PULSE OXIMETER SYSTEM

Model Number	3301
Medical Device Problem Code	Low Readings (2460)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/01/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was stated that the doctors and nurses were giving a patient low spo2, "in the 80".When they send the patient to the emergency room, they get a call from the emergency room stating the spo2 was 93.There was patient involvement but no patient harm/adverse event reported.
Additional Manufacturer Narrative
Date of event is unknown, no information has been provided to date.Device has not been returned to date.Investigation including root cause analysis is in progress.A supplemental mdr will be filed as necessary in accordance with 21 cfr 803.56 when additional reportable information becomes available.
Additional Manufacturer Narrative
H6 - updated.No product was not returned, and no photographic/diagnosis evidence was provided to aid in this investigation.As a result, a product evaluation and problem confirmation cannot be performed.Therefore, the complaint is not confirmed.If we receive the device, we will reopen the investigation for further evaluation.Based on the reported problem, the most probable cause is a usage error.The product's history records were reviewed and there were no non-conformances nor service-related issues that would have resulted in the reported complaint.

• Brand Name: BCI MONITOR HAND HELD PULSE OXIMETER SYSTEM
• Common Device Name: OXIMETER
• Manufacturer (Section D): SMITHS MEDICAL ASD, INC.; 6000 nathan ln n; minneapolis MN 55442
• Manufacturer Contact: reed covert ; 6000 nathan lane north; minneapolis, MN 55442 ; 2247062300
• MDR Report Key: 18951030
• Report Number: 3012307300-2024-01521
• Device Sequence Number: 7085051
• Product Code: DQA
• UDI-Device Identifier: 30843418000849
• UDI-Public: (01)30843418000849(11)230809
• Combination Product (Y/N): N
• Initial Reporter State: CO
• Initial Reporter Country: US
• PMA/510(K) Number: K943404
• 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: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 05/20/2024

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: 3301
• Device Catalogue Number: 3301A1
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/22/2024
• Supplement Date Received by Manufacturer: 04/23/2024
• Initial Report FDA Received Date: 03/21/2024
• Supplement Report FDA Received Date: 05/24/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 08/09/2023
• 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