FDA Adverse Event Death Summary report: N

SIRECUST 404-1A PATIENT MONITOR

MDR report key: 740 · Received June 22, 1992

Report

Report Number
740
Event Type
Death
Date Received
June 22, 1992
Date of Event
May 21, 1992
Report Date
June 2, 1992
Manufacturer
SIEMENS MEDICAL DEVICES
Product Code
KMI
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

MONITOR ALARM MALFUNCTIONED? NO AUDIBLE ALARM NOTED BY NURSING PERSONNEL FOR ASYSTOLE STATUS OF PATIENT. ALARM CONDITION OCCURING IN ROOM 8 AND THREE NURSES PRESENT AT BEDSIDE DID NOT HEAR ALARM OCCURING IN ROOM 206-0. NO MONITOR STRIPS GENERATED DURING PERIOD OF ASYSTOLE AND PT IN ROOM 206 DISCOVERED ASYSTOLIC. PATIENT EXPIRED POST CODE 99! PATIENT WAS 84 YEAR OLD MALE RECENT MI-POST CARDIAC CATHERIZATION WITH SEVERE MULTIPLE VESSEL DISEASE REQUIRING OPEN HEART SURGERY-WHICH PATIENT REFUSED TO HAVE PERFORMED. PATIENT STATUS CRITICAL PRIOR TO EVENT AND CARDIAC STATUS SEVERE DAMAGE AND INVOLVEMENTINVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: CRITICAL CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: 01-APR-92. SERVICE PROVIDED BY: USER FACILITY BIOMEDICAL/BIOENGINEERING DEPARTMENT. SERVICE RECORDS AVAILABLE.IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, COMPUTER SOFTWARE PERFORMANCE TESTS CONDUCTED, ELECTRICAL TESTS PERFORMED, PERFORMANCE TESTS PERFORMED. RESULTS OF EVALUATION: NONE OR UNKNOWN. CONCLUSION: DEVICE EVALUATED AND ALLEGED FAILURE COULD NOT BE DUPLICATED. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: DEVICE TEMPORARILY REMOVED FROM SERVICE. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SIRECUST 404-1A PATIENT MONITOR PATIENT MONITOR KMI SIEMENS MEDICAL DEVICES 404-1A

Patients

Seq Age Sex Outcome Treatment
1 84 YR Death