MAUDE Adverse Event Report: ZYNO MEDICAL, LLC ZYNO MEDICAL Z-800 INFUSION PUMP SYSTEM; LARGE VOLUME INFUSION PUMP

Model Number	Z800WF
Medical Device Problem Codes	Device Alarm System (1012); Excess Flow or Over-Infusion (1311); Mechanical Problem (1384); Calibration Problem (2890); Infusion or Flow Problem (2964); Pressure Problem (3012)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/09/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
There are no previous complaints on the device related to the issue.This pump underwent routine maintenance testing by "intuvie" provider where it was detected that the pump had a system error interruption mid test and flowrate issue.Consequently, it necessitated to replace the peristaltic motor.The replacement of the component and flowrate calibration from 5 to 0 confirmed to have successfully addressed the issues.A capa has been opened in order to fully investigate and address the root cause of the reported event.Reference to complaint #(b)(4).
Event or Problem Description
On 10/09/2024, znyo medical received a report that during the preventive maintenance (pm), the pump had a system error interruption mid test and a flow rate offset issue.No patient was involved.
Additional Manufacturer Narrative
Upon reassessment, the reported flow rate failure mode has been determined to be non-reportable.Events involving a faster flow rate are not reportable when flow rate accuracy is above +5% but below +15% specification.The severity of this failure is 1 - inconvenience or temporary discomfort.Our evaluation concluded that the event did not pose a risk to the health of patients, users, or bystanders.Furthermore, the report did not allege a serious injury or death, nor would a recurrence of the reported issue be expected to cause or contribute to a serious injury or death.Upon reassessment, the reported system error failure mode has been determined to be non-reportable.It was determined that events involving a system error alarm during infusion are not reportable.The occurrence of system error represents a severity of 2 - minor injury to the patient or user not requiring professional medical intervention.Our evaluation concluded that this complaint reported did not pose risk to health to patient, users or bystanders, did not allege a serious injury or death and would not cause or contribute to a serious injury or death if the reported issue recurred.Therefore, this event is not reportable.Reference to complaint #: (b)(4).

• Brand Name: ZYNO MEDICAL Z-800 INFUSION PUMP SYSTEM
• Common Device Name: LARGE VOLUME INFUSION PUMP
• Manufacturer (Section D): ZYNO MEDICAL, LLC; 177 pine street; natick MA 01760
• Manufacturer (Section G): ZYNO MEDICAL, LLC; 177 pine street; natick MA 01760
• Manufacturer Contact: frederick lee ; 177 pine street; natick, MA 01760 ; 5086502008
• MDR Report Key: 20540552
• Report Number: 3006575795-2024-01017
• Device Sequence Number: 20493392
• Product Code: FRN
• UDI-Device Identifier: 00814371020037
• UDI-Public: 00814371020037
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: K130690
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other,Company Representative
• Initial Reporter Occupation: Biomedical Engineer
• Type of Report: Initial,Followup
• Report Date (Section B): 05/02/2025

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: Other
• Device Model Number: Z800WF
• Device Catalogue Number: Z800WF
• Device Lot Number: 20121213-SH
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/04/2023
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/09/2024
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 10/26/2024
• Supplement Report FDA Received Date: 05/02/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 11/27/2013
• 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: Unknown
• Patient Sequence Number: 1
• Patient Sex: Unknown