FDA Adverse Event Malfunction Summary report: N

INTELLIVUE MULTI MEASUREMENT SRVER X2

MDR report key: 2953942 · Received January 14, 2013

Report

Report Number
9610816-2013-00018
Event Type
Malfunction
Date Received
January 14, 2013
Report Date
December 21, 2012
Manufacturer
PHILIPS MEDICAL SYSTEMS
Product Code
MHX
PMA / PMN Number
K071426
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
GM
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

(B)(4). SPEAKER MALFUNCTION INOP CONFIRMED THE PROBLEM. WHEN THERE IS A LOSS OF AUDIO, THE DEVICE IS DESIGNED (AS DOCUMENTED IN THE RISK MGMT SUMMARY (RMS)) TO GENERATE A "SPEAKER MALFUNCTION" INOP. IT IS CONSIDERED THAT THE INOP WOULD MAKE THE ISSUE IMMEDIATELY OBVIOUS TO USERS DURING CLOSE OBSERVATION OF THE PT. THE IMPORTANCE OF USING THE MONITORING EQUIPMENT IN CONJUNCTION WITH CLOSE PERSONAL OBSERVATION OF THE PT IS STATED IN THE PRODUCT LABELING. THE LABELING (INTELIVUE X2 MULTI-MEASUREMENT MODULE, INSTRUCTIONS FOR USE, PART NUMBER 453564208381, PAGE 57) DESCRIBES PERSONAL SURVEILLANCE: "WARNING - DO NOT RELY EXCLUSIVELY ON THE AUDIBLE ALARM SYS FOR PT MONITORING. ADJUSTMENT OF ALARM VOLUME TO A LOW LEVEL OR OFF DURING PT MONITORING MAY RESULT IN PT DANGER. REMEMBER THAT THE MOST RELIABLE METHOD OF PT MONITORING COMBINES CLOSE PERSONAL SURVEILLANCE WITH CORRECT OPERATION OF MONITORING EQUIPMENT." THIS WOULD ALLOW THE USER TO IMPLEMENT ALTERNATIVE METHODS OF MONITORING (IF NOT ALREADY APPLIED) PER HOSPITAL PROTOCOL, AND/OR TO TROUBLESHOOT THE MONITOR. THE VISUAL INOP, TOGETHER WITH THE ABOVE PRODUCT LABELING, IS CONSIDERED AS SUFFICIENT MITIGATION OF RISK FROM LOSS OF AUDIO. DESPITE THIS, PHILIPS HEALTHCARE HAS A POLICY TO REPORT A LOSS OF AUDIO, THEREFORE, THIS COMPLAINT HAS BEEN EVALUATED TO BE REPORTABLE. PHILIPS IS IN THE PROCESS OF OBTAINING ADD'L INFO REGARDING THIS INCIDENT AND THE COMPLAINT IS STILL UNDER INVESTIGATION. A FINAL REPORT WILL BE SUBMITTED ONCE THE INVESTIGATION IS COMPLETED.

Description of Event or Problem · 1

THE CUSTOMER REPORTED THAT THE DEVICE ISSUED A "SPEAKER MALFUNCTION." INOP TOGETHER WITH A LOSS OF AUDIO. THERE WAS NO ALLEGATION OF A DEATH OR A SERIOUS INJURY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
20237 INTELLIVUE MULTI MEASUREMENT SRVER X2 MHX PHILIPS MEDICAL SYSTEMS M3002A

Patients

Seq Age Sex Outcome Treatment
1