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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDIVANCE -1725056 ARCTIC SUN® TEMPERATURE MANAGEMENT SYSTEM, ARCTICGEL¿ PADS; ARCTIC GEL PADS

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MEDIVANCE -1725056 ARCTIC SUN® TEMPERATURE MANAGEMENT SYSTEM, ARCTICGEL¿ PADS; ARCTIC GEL PADS Back to Search Results
Catalog Number 317-05-02
Medical Device Problem Code Missing Information (4053)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 05/14/2026
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
The initial reporter's phone number: (b)(6).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: sections 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 the manufacture label, which should be affixed to the bottom right of the product, was missing in an arctic gel pad.The incident occurred before use.
 
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Brand Name
ARCTIC SUN® TEMPERATURE MANAGEMENT SYSTEM, ARCTICGEL¿ PADS
Common Device Name
ARCTIC GEL PADS
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 Key25235804
Report Number1018233-2026-03289
Device Sequence Number10289822
Product Code DWJ
UDI-Device Identifier00801741080067
UDI-Public(01)00801741080067(17)270228(10)NGKQ0143
Combination Product (Y/N)N
Initial Reporter CountryKS
PMA/510(K) Number
K161602
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Other,Company Representative
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 05/15/2026
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 Number317-05-02
Device Lot NumberNGKQ0143
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 05/14/2026
Initial Report FDA Received Date05/20/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Is the Device Labeled for Single Use? (Y/N) Yes
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Usage of Device Initial
Patient Sequence Number1
Outcome Attributed to Adverse Event Other;
Patient SexUnknown
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