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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDIVANCE, INC. ¿ 1725056 ARCTIC SUN STAT; ARCTIC SUN DEVICE

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MEDIVANCE, INC. ¿ 1725056 ARCTIC SUN STAT; ARCTIC SUN DEVICE Back to Search Results
Catalog Number 60000000L
Medical Device Problem Codes Defective Component (2292); Computer Operating System Problem (2898)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 05/20/2025
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
The investigation is still in progress.Once the investigation is complete a supplemental report will be filed.Udi format updated with available product information per gudid.H11: section a through f - the information provided by bd represents all the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.
 
Event or Problem Description
It was reported that in an arctic sun device during alarm 113 field action update control panel froze / reboot unit to control panel screen, inverted screen - enter password.
 
Additional Manufacturer Narrative
The reported issue was confirmed.The root cause of the reported issue is due to a failed control panel.During evaluation, it was confirmed that the control panel was not functioning to specification.Control panel was replaced.The arctic sun 6000 passed all performance testing, calibration, and electrical safety tests.The unit is ready for use.The complaint or reported issue was confirmed through other elements of the investigation to not be labeling or packaging related.A review of the device history records did not show any problems or conditions that would have contributed to the reported issue.Based on the results of the investigation, no additional actions are needed.Correction: d, f, h udi format updated with available product information per gudid.H11: section a through f - the information provided by bd represents all the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.
 
Event or Problem Description
It was reported that in an arctic sun device during alarm 113 field action update control panel froze / reboot unit to control panel screen, inverted screen - enter password.
 
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Brand Name
ARCTIC SUN STAT
Common Device Name
ARCTIC SUN DEVICE
Manufacturer (Section D)
MEDIVANCE, INC. ¿ 1725056
321 s taylor ave
suite 200
louisville 80027
Manufacturer (Section G)
MEDIVANCE, INC. ¿ 1725056
321 s taylor ave
suite 200
louisville CO 80027
Manufacturer Contact
xeeroy rada
8195 industrial blvd
covington, GA 30014
7707846100
MDR Report Key22077573
Report Number1018233-2025-03806
Device Sequence Number15793483
Product Code DWJ
UDI-Device Identifier00801741161520
UDI-Public(01)00801741161520(11)210114
Combination Product (Y/N)N
Initial Reporter StateCA
Initial Reporter CountryUS
PMA/510(K) Number
K200225
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Other,Health Professional,User Facility
Initial Reporter Occupation Physician
Type of Report Initial,Followup
Report Date (Section B) 08/01/2025
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 Health Professional
Device Catalogue Number60000000L
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer05/20/2025
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 05/20/2025
Supplement Date Received by Manufacturer08/01/2025
Initial Report FDA Received Date05/23/2025
Supplement Report FDA Received Date08/04/2025
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured01/14/2021
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
Outcome Attributed to Adverse Event Other;
Patient SexUnknown
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