MAUDE Adverse Event Report: FRESENIUS VIAL S.A.S. AGILIA VP MC WIFI US; INFUSION PUMP SYSTEM

Model Number	Z019735
Medical Device Problem Code	No Apparent Adverse Event (3189)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/17/2025
Type of Reportable Event	Malfunction
Event or Problem Description
The following has been reported by customer: customer reported error 41-0002.Reporting as a conservative measure.Adverse effects were not reported.More information is needed to complete the investigation.Device history record was reviewed and nothing was found related to the reported event.Device log history was not provided therefore no review could be performed.The reported device was not returned to lake zurich nor brézins for investigation.According to local protocol, if after 15 days the device still hasn't been returned, the service order is closed to no device.So, we did not receive anything that would allow us to identify the actual root cause of this event / to go further with this investigation.Therefore, the root cause of the reported issue could not be identified.However, if further information are provided later on, we may re-open the complaint and pursue its.To our knowledge this complaint is not being related to patient safety.This complaint is considered as: not investigated.The trend is: normal.

• Brand Name: AGILIA VP MC WIFI US
• Common Device Name: INFUSION PUMP SYSTEM
• Manufacturer (Section D): FRESENIUS VIAL S.A.S.; le grand chemin; brezins, 38590 ; FR 38590
• Manufacturer (Section G): FRESENIUS VIAL S.A.S.; le grand chemin; brezins, 38590 ; FR 38590
• Manufacturer Contact: rebecca mccandless ; 3 corporate drive; lake zurich, IL 60047 ; 8475502913
• MDR Report Key: 22784408
• Report Number: 3000240707-2025-00413
• Device Sequence Number: 9869341
• Product Code: FRN
• UDI-Device Identifier: 04086000856089
• UDI-Public: 04086000856089
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: K210073
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: User Facility
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 08/12/2025

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: Z019735
• Device Catalogue Number: Z019735
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/17/2025
• Initial Report FDA Received Date: 08/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 01/13/2023
• 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