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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDIVANCE -1725056 ARCTIC SUN® 5000; ARCTIC SUN DEVICE

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MEDIVANCE -1725056 ARCTIC SUN® 5000; ARCTIC SUN DEVICE Back to Search Results
Catalog Number 50000000L
Medical Device Problem Codes Insufficient Cooling (1130); Failure to Pump (1502)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 04/03/2026
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 per wo evaluation, decon tech install test mixing pump to cool in an arctic sun device.
 
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Brand Name
ARCTIC SUN® 5000
Common Device Name
ARCTIC SUN DEVICE
Manufacturer (Section D)
MEDIVANCE -1725056
321 south taylor ave
suite 200
louisville CO 80027
Manufacturer (Section G)
MEDIVANCE -1725056
321 south taylor ave
suite 200
louisville CO 80027
Manufacturer Contact
xeeroy rada
8195 industrial blvd
covington, GA 30014
7707846100
MDR Report Key24831631
Report Number1018233-2026-02360
Device Sequence Number21409003
Product Code DWJ
UDI-Device Identifier00801741080159
UDI-Public(01)00801741080159(11)150301
Combination Product (Y/N)N
Initial Reporter StateMD
Initial Reporter CountryUS
PMA/510(K) Number
K161602
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) 05/28/2026
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 Number50000000L
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer04/02/2026
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 04/03/2026
Supplement Date Received by Manufacturer05/28/2026
Initial Report FDA Received Date04/09/2026
Supplement Report FDA Received Date06/08/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured03/01/2015
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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