BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIFEVEST WCD 3100 SYSTEM

    MDR report key: 1021902 · Received March 28, 2008

    Report

    Report Number
    3002158293-2008-00135
    Event Type
    Malfunction
    Date Received
    March 28, 2008
    Date of Event
    March 16, 2008
    Report Date
    March 27, 2008
    Manufacturer
    ZOLL LIFECOR CORPORATION
    Product Code
    MVK
    PMA / PMN Number
    P010030
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE EVAL OF MONITOR HAS BEEN COMPLETED. THE REPORTED PROBLEM WAS CONFIRMED. THE MONITOR WAS FOUND TO HAVE A DEFECTIVE BATTERY CONNECTOR. THE CONNECTOR PINS WERE BENT. THE CONNECTOR WAS REPAIRED. THE MONITOR WAS RETESTED AND THEN RESTOCKED. THE ROOT CAUSE OF THE BENT PINS IS UNK, BUT IS LIKELY DUE TO A BATTERY PACK BEING FORCED INTO A MONITOR WITH THE CONNECTORS MISALIGNED. THE DAMAGED CONNECTOR ON THE MONITOR. NO ADVERSE EVENTS RESULTED FROM THE DAMAGED MONITOR. THE PT RECEIVED A REPLACEMENT MONITOR.

    Description of Event or Problem · 1

    THE HUSBAND OF A FEMALE PT CONTACTED LIFECOR CUSTOMER SUPPORT TO REPORT THAT NEITHER BATTERY PACK WOULD START THE MONITOR. SUPPORT SENT THE LIFECOR TERRITORY MANAGER TO THE PT. SHE REPORTED THAT THERE WAS BENT PINS INSIDE THE MONITOR, BUT BOTH BATTERY PACKS WERE NOT DAMAGED. SHE EXCHANGED THE PT'S MONITOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIFEVEST WCD 3100 SYSTEM WEARABLE CARDIOVERTER DEFIBRILLATOR MVK ZOLL LIFECOR CORPORATION WCD 3100 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR