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U.S. Department of Health and Human Services

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

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PHYSIO-CONTROL, INC. - 3015876 LIFEPAK(R) 20E DEFIBRILLATOR/MONITOR; AUTOMATED EXTERNAL DEFIBRILLATORS (NON-WEARABLE) Back to Search Results
Model Number 20E
Medical Device Problem Codes Failure to Deliver Shock/Stimulation (1133); Key or Button Unresponsive/not Working (4063)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 07/08/2024
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Stryker continues to investigate the reported failure 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 provide defibrillation therapy because the sync button was jammed.As a result, defibrillation would not be available, if needed.There was no patient use associated with the reported event.
 
Additional Manufacturer Narrative
Stryke evaluated the customer's device and was unable to duplicate the reported issue but was able to verify it in the device's electronic files.Stryker replaced the user interface (ui) pcb assembly as a precautionary measure.Proper device operation was observed through functional and performance testing and the device was, subsequently, returned to the customer for use.The replaced ui pcb assembly was returned to stryker product analysis center (pac) for further evaluation.The pac technician was not able to duplicate the reported issue.Therefore, a root cause could not be determined.
 
Event or Problem Description
The customer contacted stryker to report that their device would not provide defibrillation therapy because the sync button was jammed.As a result, defibrillation would not be available, if needed.There was no patient use associated with the reported event.
 
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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 Key19746884
Report Number0003015876-2024-02188
Device Sequence Number12395064
Product Code MKJ
UDI-Device Identifier00883873813829
UDI-Public00883873813829
Combination Product (Y/N)N
Initial Reporter StateTX
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) 11/27/2024
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 Number99507-000016
Was Device Available for Evaluation? Device Returned to Manufacturer
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 07/08/2024
Supplement Date Received by Manufacturer11/20/2024
Initial Report FDA Received Date07/15/2024
Supplement Report FDA Received Date11/27/2024
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured10/08/2019
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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