BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIFEVEST WCD 4000 SYSTEM

    MDR report key: 1843704 · Received September 21, 2010

    Report

    Report Number
    3002158293-2010-00950
    Event Type
    Malfunction
    Date Received
    September 21, 2010
    Date of Event
    August 28, 2010
    Report Date
    September 20, 2010
    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 EVALUATION SUMMARY: EVALUATION OF MONITOR (B)(4) HAS BEEN COMPLETED. THE REPORTED PROBLEM (BROKEN MONITOR) HAS BEEN CONFIRMED. UPON EVALUATION, IT WAS DISCOVERED THAT THE MONITOR HAD A DEFECTIVE FRONT RESPONSE BUTTON. THE CAUSE OF THE DEFECTIVE RESPONSE BUTTON WAS A CRACKED CONDUCTOR ON THE FLEX CIRCUIT TAIL. THE ROOT CAUSE APPEARS TO BE AN ASSEMBLY ERROR. THE FLEX CIRCUIT WAS INADVERTENTLY CREASED BENEATH THE DISPLAY ENCLOSURE. NO ADVERSE EVENT RESULTED FROM THE DEFECTIVE MONITOR. THE PT REC'D A REPLACEMENT MONITOR.

    Description of Event or Problem · 1

    THE PT SERVICE REP (PSR) ASSISTING A (B)(6) OLD MALE PT CONTACTED ZOLL LIFECOR CUSTOMER SUPPORT SERVICE TO REPORT THE PT'S MONITOR IS BROKEN. THE PT WAS PROVIDED WITH A REPLACEMENT MONITOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIFEVEST WCD 4000 SYSTEM WEARABLE CARDIOVERTER DEFIBRILLATOR MVK ZOLL LIFECOR CORPORATION WCD4000 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR