BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIFEVEST WCD 3000 SYSTEM

    MDR report key: 1882482 · Received October 21, 2010

    Report

    Report Number
    3002158293-2010-01074
    Event Type
    Malfunction
    Date Received
    October 21, 2010
    Date of Event
    September 24, 2010
    Report Date
    October 18, 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 EVAL SUMMARY: DEVICE EVAL OF ELECTRODE BELT (B)(4) HAS BEEN COMPLETED. THE REPORTED PROBLEM (BELT GELLED) HAS BEEN CONFIRMED. UPON INSPECTION, THE ELECTRODE BELT WAS FOUND TO HAVE THE CONNECTOR PINS BELT. THE ELECTRODE BELT CONNECTOR PINS DID NOT SUCCESSFULLY MATE WITH THE CONNECTOR. THE ROOT CAUSE OF THE BENT PINS CANNOT BE POSITIVELY IDENTIFIED BUT WAS LIKELY DUE TO THE CONNECTOR BEING FORCED INTO THE MONITOR WHILE THE PINS WERE MISALIGNED. NO ADVERSE EVENT RESULTED FROM BENT CONNECTOR PINS. THE PT RECEIVED A REPLACEMENT ELECTRODE BELT.

    Description of Event or Problem · 1

    A (B)(6) OLD MALE PT CALLED IN TO ZOLL LIFECOR CUSTOMER SUPPORT TO REPORT THAT ONE OF HIS BACK THERAPY ELECTRODES GELLED. THE PT RECEIVED A REPLACEMENT 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 3000 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR