BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIFEVEST WCD 3000 SYSTEM

    MDR report key: 1203228 · Received October 9, 2008

    Report

    Report Number
    3002158293-2008-00527
    Event Type
    Malfunction
    Date Received
    October 9, 2008
    Date of Event
    September 22, 2008
    Report Date
    October 8, 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 SUMMARY: DEVICE EVAL OF ELECTRODE BELT HAS BEEN COMPLETED. THE PROBLEM WAS CONFIRMED. UPON FURTHER INSPECTION, ELECTRODE BELT HAD PINS THAT WERE BENT INSIDE THE CONNECTOR. THE ROOT CAUSE OF THE BENT PINS WAS PROBABLY EXCESSIVE FORCE APPLIED TO THE CONNECTOR DURING MATING. THE CONNECTOR WAS FORCED INTO THE MONITOR WHICH DEFEATED THE CONNECTOR KEYING MECHANISM AND ALLOWED THE PINS TO MISALIGN WITH THE MATING SOCKETS. THE DAMAGED ELECTRODE BELT CONNECTOR WAS REPLACED. THE ELECTRODE BELT WAS RETESTED AND THEN RESTOCKED. NO ADVERSE EVENT RESULTED FROM THE BENT PINS. THE PT RECEIVED A REPLACEMENT ELECTRODE BELT.

    Description of Event or Problem · 1

    THE FATHER OF A FEMALE PT CONTACTED LIFECOR CUSTOMER SUPPORT TO REPORT THAT HIS DAUGHTER'S ELECTRODE BELT WILL NOT CONNECT TO THE MONITOR. THE FATHER ADMITTED TO DISCONNECTING, AND RECONNECTING THE ELECTRODE BELT LAST NIGHT AND THIS MORNING. HE STATED THAT THIS MORNING HE NOTICED THAT SEVERAL OF THE PINS WERE BENT IN THE CONNECTOR. SUPPORT SENT A PT SERVICES REP (PSR) TO THE PT TO REPLACE THE ELECTRODE BELT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIFEVEST WCD 3000 SYSTEM WEARABLE CARDIOVERTER DEFIBRILLATOR MVK ZOLL LIFECOR CORPORATION WCD 3100 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 10 YR