| Catalog Number |
191130 |
| Medical Device Problem Code |
Thermal Decomposition of Device (1071)
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| Health Effect - Clinical Code |
No Clinical Signs, Symptoms or Conditions (4582)
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| Date of Event |
08/21/2025
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Type of Reportable Event
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Malfunction
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Additional Manufacturer Narrative
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The plant investigation is in process.A supplemental mdr will be submitted upon completion of this activity. .
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Event or Problem Description
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A user facility's biomedical technician (bmt) reported to technical support that a 2008t hemodialysis (hd) machine displayed a "bicarb pump no eos" message during power up.A fresenius field service technician (fst) was called onsite and ordered a bicarbonate pump for the customer.The customer received the new bicarbonate pump and during installation saw that the original bicarbonate pump had brown and black burn marks on the hydraulic frame and the distribution cover.A patient was not connected to the machine at the time of the incident and there was no harm to any patients or individuals because of this malfunction.The bicarbonate pump was the original fresenius part on the machine.The bmt reported that there was no melting, burning smell, smoke, spark, flame, or arcing observed.The bmt reported that the machine has not had any past problems with failing the electrical leakage test and that there was no damage observed on any other components.The machine has approximately 1,583 hours and is plugged into a hospital grade ground-fault circuit interrupter (gfci) outlet.The bmt replaced the bicarbonate pump, which resolved the issue.The bmt reported that the machine has been returned to service without issue.The bicarbonate pump is not available to be returned to the manufacturer for physical evaluation; however, two photos are available.
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Additional Manufacturer Narrative
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Plant investigation: no parts were returned to the manufacturer for physical evaluation.However, an on-site evaluation was performed by a fresenius field service technician (fst).To resolve the reported issue, the fst ordered a bicarbonate pump for the customer that they subsequently received and installed.A records review was performed on the reported serial number.An investigation of the device manufacturing records was conducted by the manufacturer.There were no non-conformances, or any associated rework identified during the manufacturing process which could be related to the reported event.In addition, the device history record (dhr) review confirmed the results of the in-progress and final quality control (qc) testing met all requirements.The investigation into the cause of the reported problem was able to confirm the reported failure mode.During the machine inspection, the fresenius fst identified burnt wires and evidence of melting.Therefore, the complaint event was confirmed.
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Event or Problem Description
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A user facility's biomedical technician (bmt) reported to technical support that a 2008t hemodialysis (hd) machine displayed a "bicarb pump no eos" message during power up.A fresenius field service technician (fst) was called onsite and ordered a bicarbonate pump for the customer.The customer received the new bicarbonate pump and during installation saw that the original bicarbonate pump had brown and black burn marks on the hydraulic frame and the distribution cover.A patient was not connected to the machine at the time of the incident and there was no harm to any patients or individuals because of this malfunction.The bicarbonate pump was the original fresenius part on the machine.The bmt reported that there was no melting, burning smell, smoke, spark, flame, or arcing observed.The bmt reported that the machine has not had any past problems with failing the electrical leakage test and that there was no damage observed on any other components.The machine has approximately 1,583 hours and is plugged into a hospital grade ground-fault circuit interrupter (gfci) outlet.The bmt replaced the bicarbonate pump, which resolved the issue.The bmt reported that the machine has been returned to service without issue.The bicarbonate pump is not available to be returned to the manufacturer for physical evaluation; however, two photos are available.
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Search Alerts/Recalls
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