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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 05/15/2026
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: 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 nurse was trying to start therapy and was getting no flow in an arctic sun device.Disconnected and reconnected pads using proper technique.They then got a probe out of range that seemed to be resolved reseating the probe.Started therapy and guided to diagnostics showed that the system hours were 13,768, pump hours were 11,917, inlet pressure (ip) was -0.4psi, circulation pump command (cpc) was 100 percentage, flow rate (fr) was 0lpm and would get a new device and send this one to biomed.
 
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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 CO 80027
Manufacturer Contact
xeeroy rada
8195 industrial blvd
covington, GA 30014
+1(770)784-6100
MDR Report Key25260782
Report Number1018233-2026-03349
Device Sequence Number12117363
Product Code DWJ
UDI-Device Identifier00801741080142
UDI-Public(01)00801741080142(11)100501
Combination Product (Y/N)N
Initial Reporter StatePA
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) 09/18/2026
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
Was the Report Sent to FDA? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 05/15/2026
Supplement Date Received by Manufacturer09/18/2026
Initial Report FDA Received Date05/22/2026
Supplement Report FDA Received Date09/25/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured05/01/2010
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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