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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDIVANCE, INC. ¿ 1725056 ARCTIC SUN 5000; ARCTIC SUN DEVICE

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MEDIVANCE, INC. ¿ 1725056 ARCTIC SUN 5000; ARCTIC SUN DEVICE Back to Search Results
Catalog Number 50000000
Medical Device Problem Code Restricted Flow rate (1248)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 04/29/2026
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that the nurse was trying to start therapy, but the arctic sun device primes and stops.Disconnected and reconnected using proper technique.Device primed and immediately stopped.Guided to diagnostics: system hours 13,787, pump hours 12,497, inlet pressure (ip) was -0.1psi, circulation pump command (cpc) was 100%, flow rate (fr) was 0 lpm.Moved pads/probe to a different as ((b)(6)).Flow rate (fr) was settled at 1.4 lpm; small pads in place.Per follow up information received via phone on 30apr2026, transferred to the biomed.Spoke with biomed who stated they had this device in their shop a week or two ago.They did not repair the device because the part had not come in time and the nurses were requesting the device back.They would look into getting a pm completed.No repairs made at this time.
 
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.
 
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Brand Name
ARCTIC SUN 5000
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 GA 80027
Manufacturer Contact
xeeroy rada
8195 industrial blvd
covington, GA 30014
7707846100
MDR Report Key25105260
Report Number1018233-2026-02997
Device Sequence Number13110496
Product Code DWJ
UDI-Device Identifier00801741080142
UDI-Public(01)00801741080142(11)121101
Combination Product (Y/N)N
Initial Reporter StateCA
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) 05/29/2026
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 Number50000000
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 04/29/2026
Supplement Date Received by Manufacturer05/29/2026
Initial Report FDA Received Date05/06/2026
Supplement Report FDA Received Date06/10/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured12/01/2012
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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