ARIAL 59350

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a user facility report with the FDA on 2016-04-15 for ARIAL 59350 manufactured by Stanley Security Solutions, Inc..

Event Text Entries

[42850977] The arial system and log files were inspected by manufacturer's technical support group. A database backup was saved both to the facility arial pc, and in manufacturer systems to allow further reporting and investigation as needed. All relevant reports run to date by manufacturer have been shared with facility. The reports indicate the system consistently and repeatedly signaled low battery as early as (b)(6) 2016, along with pendant alarms on (b)(6) 2016. Low battery alarms are seen to repeat no more than 1 minute after each low battery reset event. The reports then show missing device alarms began on (b)(6) 2016, with the first occurring at 6:37 am reset at 1:06 pm, with the last missing device alarm shown in the reports before the incident on (b)(6) 2016 at 10:50 pm. No additional transmissions were reported for the missing device until after the incident on (b)(6) 2016, when facility reported battery was changed and pendant was tested. A field service representative (fsr) was also dispatched to the facility on (b)(4) 2016 to inspect additional pendants for signs of moisture ingress. The fsr inspected 21 pendants from the same lot code, and no additional pendants were found to contain moisture when opened. The pendants were also tested for transmission functionality and performed according to specifications. Based on the above information, it is unlikely that moisture in the pendant reported by facility caused a failure of operation. Regardless of the status of moisture, the pendant signaled low battery status for a full week before full depletion; if moisture were having an effect, a much shorter time between low battery signaling and missing device alarm due to internal shorting would be expected. Additionally, two pendant alarms (calls for assistance) were signaled during the low battery status, indicating that the device remained operational in its low battery state. Rather, review of reports for the incident pendant show low battery followed by missing device one week later, and measured voltage of the replaced battery indicates that the battery had insufficient charge to signal the arial system. Additional inspection of devices from the same lot in situ did not find other pendants with signs of moisture ingress. Device lost on receipt at mfr.
Patient Sequence No: 1, Text Type: N, H10


[42850978] The user facility reported to manufacturer that a resident had fallen and suffered a broken hip. Although the resident was reported to have activated his pendant to signal a call for assistance, no call was reported as received by the call station. Upon facility examination of the device, it was reported that moisture was found inside. After the moisture was removed and battery replace, the device was tested and operated normally. The resident was later reported to have undergone surgery and was stated to be recovering at a different facility.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1929691-2016-00001
MDR Report Key5582446
Report SourceUSER FACILITY
Date Received2016-04-15
Date of Report2016-04-15
Date of Event2016-03-17
Date Mfgr Received2016-03-18
Date Added to Maude2016-04-15
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. GINA BENNETT
Manufacturer Street4600 VINE STREET
Manufacturer CityLINCOLN NE 68503
Manufacturer CountryUS
Manufacturer Postal68503
Manufacturer Phone4072712097
Manufacturer G1STANLEY SECURITY SOLUTIONS, INC.
Manufacturer Street4600 VINE STREET
Manufacturer CityLINCOLN NE 68503
Manufacturer CountryUS
Manufacturer Postal Code68503
Single Use3
Remedial ActionRL
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameARIAL
Generic NameENVIRONMENTAL CONTROL SYSTEM, POWERED
Product CodeIQA
Date Received2016-04-15
Model Number59350
Catalog Number59350
Lot Number15119
OperatorLAY USER/PATIENT
Device AvailabilityN
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerSTANLEY SECURITY SOLUTIONS, INC.
Manufacturer Address4600 VINE STREET LINCOLN NE 68503 US 68503


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2016-04-15

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