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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: CONCORD MANUFACTURING LIBERTY SELECT CYCLER ASSY(NON-VALUATED) SYSTEM, PERITONEAL, AUTOMATIC DELIVERY

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CONCORD MANUFACTURING LIBERTY SELECT CYCLER ASSY(NON-VALUATED) SYSTEM, PERITONEAL, AUTOMATIC DELIVERY Back to Search Results
Catalog Number RTLR180343
Device Problem Thermal Decomposition of Device
Event Date 04/07/2019
Event Type  Malfunction  
Manufacturer Narrative

Plant investigation: the actual device was returned to the manufacturer for physical evaluation. An exterior visual inspection of the returned cycler showed no signs of physical damage. Upon power up, the cycler touch screen test failed. When powering on the cycler, the ok, stop and up/down arrow push buttons illuminated; however, the front panel touch screen remained blank. It was identified that the cause for the blank screen was due to an internal short on transformer (t1) on the inverter board. The inverter board is located on the rear of the touch screen. A known good inverter board was installed and the display became fully operational. An internal visual inspection of the returned cycler encountered no other discrepancies. A review of the device manufacturing records was conducted by the manufacturer. There were no deviations or non-conformances during the manufacturing process. In addition, a device history record (dhr) review was performed and verified that the results of the in-progress and final quality control (qc) testing met all requirements. Upon completion of the evaluation, the reported issue was confirmed and the cause was determined to be a shorted transformer on the inverter board. The cycler was refurbished following the evaluation.

 
Event Description

It was reported that the screen of a patient¿s liberty select cycler went blank during setup for their peritoneal dialysis (pd) treatment. The power cord was properly connected in both ends and cycler plugged directly into a three prong wall outlet that was shared. The cycler was rebooted and the ok and stop keys were on; however, the screen remained blank. At that point in time, the technical support representative advised the patient to discontinue use of the cycler and to notify their peritoneal dialysis registered nurse (pdrn) of the event. A replacement cycler was issued to the patient. It was reported that an alternate treatment option was available. Upon follow up, the patient confirmed that there were no adverse events or medical intervention required as a result of the reported event. The patient did not complete treatment. The cycler was returned to the manufacturer and a replacement cycler was provided and received. Upon physical evaluation of the cycler by the manufacturer, there was evidence of an internal short on the transformer on the inverter board.

 
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Brand NameLIBERTY SELECT CYCLER ASSY(NON-VALUATED)
Type of DeviceSYSTEM, PERITONEAL, AUTOMATIC DELIVERY
Manufacturer (Section D)
CONCORD MANUFACTURING
4040 nelson avenue
concord CA 94520
Manufacturer (Section G)
CONCORD MANUFACTURING
director, quality systems
4040 nelson avenue
concord CA 94520
Manufacturer Contact
matthew amaral
920 winter st.
waltham , MA 02451
7816999758
MDR Report Key8561241
Report Number2937457-2019-01247
Device Sequence Number1
Product CodeFKX
Report Source Manufacturer
Source Type CONSUMER
Reporter Occupation
Type of Report Initial
Report Date 04/29/2019
1 Device Was Involved in the Event
0 PatientS WERE Involved in the Event:
Date FDA Received04/29/2019
Is This A Product Problem Report? Yes
Device Operator LAY USER/PATIENT
Device Catalogue NumberRTLR180343
Was Device Available For Evaluation? Device Returned To Manufacturer
Date Returned to Manufacturer04/17/2019
Is The Reporter A Health Professional?
Was the Report Sent to FDA?
Device Age mo
Event Location No Information
Date Manufacturer Received04/07/2019
Was Device Evaluated By Manufacturer? Yes
Date Device Manufactured11/19/2018
Is The Device Single Use? No
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Reuse

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