FDA Adverse Event Malfunction Summary report: N

HEARTSTART XL+ DEFIBRILLATOR/MONITOR

MDR report key: 12888434 · Received November 29, 2021

Report

Report Number
3030677-2021-15975
Event Type
Malfunction
Date Received
November 29, 2021
Date of Event
November 1, 2021
Manufacturer
PHILIPS NORTH AMERICA LLC
Product Code
MKJ
UDI-DI
00884838023680
PMA / PMN Number
K110825
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
UK
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Description of Event or Problem · 0

THE CUSTOMER REPORTED THAT THE DEVICE FAILED ONE OF THE CHECKS WHILE CONDUCTING ROUTINE MAINTENANCE. WHEN THE CUSTOMER TRIED TO SHOCK THE DEVICE IN SYNC MODE, THE PRESSED BUTTON WOULDN¿T REGISTER. THE CUSTOMER KEPT THE BUTTON PRESSED AS SPECIFIED, BUT THE DEVICE WOULDN¿T SHOCK. THERE WAS NO PATIENT INVOLVEMENT. THE DEVICE WAS RECEIVED BY BENCH REPAIR ON (B)(6)2021. THE NOTED FAILURE WAS IDENTIFIED DURING INSPECTION OF THE DEVICE BY AN AUTHORIZED BENCH TECHNICIAN. AS A RESULT OF THE ISSUE, IT WAS DETERMINED THAT THE MULTIPLE PARTS WOULD NEED TO BE REPLACED. UPON CONCLUSION OF THE EVALUATION, IT WAS DETERMINED THAT THIS WAS A MALFUNCTION OF THE PROCESSOR PCA AND HIF PCA. THE PROCESSOR PCA AND HIF PCA WERE REPLACED TO RESOLVE THE REPORTED ISSUE AND THE DEVICE WAS SCHEDULED TO BE RETURNED TO THE CUSTOMER SITE. NO FURTHER EVALUATION IS REQUIRED AT THIS TIME.

Description of Event or Problem · 0

THE CUSTOMER REPORTED THAT THE DEVICE FAILED ONE OF THE CHECKS WHILE CONDUCTING ROUTINE MAINTENANCE. WHEN THE CUSTOMER TRIED TO SHOCK THE DEVICE IN SYNC MODE, THE PRESSED BUTTON WOULDN¿T REGISTER. THE CUSTOMER KEPT THE BUTTON PRESSED AS SPECIFIED, BUT THE DEVICE WOULDN¿T SHOCK. THERE WAS NO PATIENT INVOLVEMENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1778310 HEARTSTART XL+ DEFIBRILLATOR/MONITOR DEFIBRILLATOR MKJ PHILIPS NORTH AMERICA LLC 861290 00884838023680

Patients

Seq Age Sex Outcome Treatment
1 Unknown