FDA Adverse Event Malfunction Summary report: N

TEMPUS LS-MANUAL

MDR report key: 17691326 · Received September 6, 2023

Report

Report Number
3003832357-2023-00583
Event Type
Malfunction
Date Received
September 6, 2023
Date of Event
April 12, 2022
Manufacturer
SCHILLER AG
Product Code
LDD
PMA / PMN Number
K200849
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Description of Event or Problem · 0

PHILIPS RECEIVED A COMPLAINT ON THE TEMPUS LS INDICATING THAT THE DEVICE FAILED TO PACE WHILE ON A SIMULATOR. NO PATIENT INVOLVED OR HARMED. THE DEVICE REQUESTED FROM THE CUSTOMER AND REPLACEMENT DEVICE HAS BEEN SENT. THE COMPLAINT WAS ESCALATED FOR TECHNICAL INVESTIGATION AND THE RESULTS INDICATE THAT ERROR 26 HAS BEEN DETECTED ON THIS DEVICE, WHICH OCCURRED ON 2022-04-11, NOT (B)(6) 2022. CONSIDERING ALL INVESTIGATION RESULTS, SCHILLER CONCLUDED THAT THIS ISSUE IS MOST LIKELY DUE TO AN INTERMITTENT LOSS OF COMMUNICATION BETWEEN THE DPM-BOARD AND THE MAINBOARD. AS THE ISSUE IS NOT CLEARLY REPRODUCIBLE, THE EXACT ROOT CAUSE CANNOT BE DETERMINED. HOWEVER, TAKING ALL COMPONENTS INTO ACCOUNT WHICH ARE PART OF THE COMMUNICATION PATH BETWEEN THE DPM-BOARD AND THE MAINBOARD, AND WHICH MAY CAUSE AN INTERMITTENT LOSS OF COMMUNICATION, THE SOURCE OF THE ISSUE IS MOST LIKELY TO BE OF A MECHANICAL NATURE SUCH AS A CONNECTOR. THEREFORE, IT IS SUSPECTED THAT THE BOARD-TO-BOARD CONNECTOR BETWEEN THE DPM-BOARD AND THE MAINBOARD MAY BE THE ROOT CAUSE FOR THIS ISSUE. AS THE ROOT CAUSE CANNOT BE VERIFIED, SCHILLER AG CANNOT COME TO A CONCLUSION. THE DATA ENTERED IN THIS COMPLAINT RECORD WILL BE UTILIZED FOR PRODUCT QUALITY AND SAFETY IMPROVEMENTS PER THE POST MARKET SURVEILLANCE AND RISK MANAGEMENT PROCESSES. THE INVESTIGATION CONCLUDES THAT NO FURTHER ACTION IS REQUIRED AT THIS TIME. IF ADDITIONAL INFORMATION IS RECEIVED THE COMPLAINT FILE WILL BE REOPENED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
858506 TEMPUS LS-MANUAL LOW ENERGY DEFIBRILLATOR LDD SCHILLER AG 00-3020

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Other