BEUDAMED
    FDA Adverse Event Death Summary report: N

    FR2

    MDR report key: 1723323 · Received June 10, 2010

    Report

    Report Number
    3030677-2010-00075
    Event Type
    Death
    Date Received
    June 10, 2010
    Date of Event
    May 8, 2010
    Report Date
    June 10, 2010
    Manufacturer
    PHILIPS MEDICAL SYSTEMS, HEARTSTREAM
    Product Code
    MKJ
    PMA / PMN Number
    003565
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    EVAL PENDING.

    Description of Event or Problem · 1

    PT DEATH DURING AED DEPLOYMENT. USER INDICATES ISSUE WITH PADS CONTACT. (B) (4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FR2 AED MKJ PHILIPS MEDICAL SYSTEMS, HEARTSTREAM M3860A-ABA

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Death