BEUDAMED
    FDA Adverse Event Death Summary report: N

    FR2

    MDR report key: 1743450 · Received June 29, 2010

    Report

    Report Number
    3030677-2010-00202
    Event Type
    Death
    Date Received
    June 29, 2010
    Date of Event
    December 13, 2009
    Report Date
    June 29, 2010
    Manufacturer
    PHILIPS MEDICAL SYSTEMS, HEARTSTREAM
    Product Code
    MKJ
    PMA / PMN Number
    003565
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    INTERNAL DEVICE MEMORY RELATED TO THE INCIDENT WAS REVIEWED. CONCLUSION: SUBJECT WAS IN A SHOCKABLE RHYTHM, MULTIPLE SHOCKS WERE ADVISED AND MULTIPLE SHOCKS WERE DELIVERED.

    Description of Event or Problem · 1

    USER REQUESTED HELP RETRIEVING DATA REGARDING AN INCIDENT WHERE THE SUBJECT WAS NOT RESUSCITATED. (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FR2 AED MKJ PHILIPS MEDICAL SYSTEMS, HEARTSTREAM M3861A-ABA

    Patients

    Seq Age Sex Outcome Treatment
    1 Death