MAUDE Adverse Event Report: MASIMO - 40 PARKER RAINBOW RC-1; OXIMETER

Model Number	2405
Medical Device Problem Code	Device Stops Intermittently (1599)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	04/24/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Additional manufacturing narrative: the product has been returned to masimo for evaluation.When the investigation is complete a follow up report will be submitted.Initial reporter zip code exceeded maximum allowable digits, zip code is as follows: (b)(6).
Event or Problem Description
The customer reported the product stopped reading.They replaced the cable and it worked fine after that.No impact or consequences to patient were reported.
Additional Manufacturer Narrative
The returned cable was evaluated.During evaluation the cable passed all visual and functional testing.The cable was determined to be functioning as designed., corrected data:.

• Brand Name: RAINBOW RC-1
• Common Device Name: OXIMETER
• Manufacturer (Section D): MASIMO - 40 PARKER; 40 parker; irvine CA 92618 1604
• MDR Report Key: 6571240
• Report Number: 2031172-2017-00568
• Device Sequence Number: 13736743
• Product Code: DQA
• UDI-Device Identifier: 00843997002301
• UDI-Public: (01)00843997002301(11)161001(10)16K5Z
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K080238
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: foreign,health professional
• Initial Reporter Occupation: Other Health Care Professional
• Remedial Action: Other
• Type of Report: Initial,Followup

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 Model Number: 2405
• Device Catalogue Number: 2405
• Device Lot Number: 16K5Z
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/09/2017
• Was the Report Sent to FDA?: Yes
• Initial Date Received by Manufacturer: 04/24/2017
• Supplement Date Received by Manufacturer: 06/13/2017
• Initial Report FDA Received Date: 05/16/2017
• Supplement Report FDA Received Date: 07/07/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1