BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PIC 50

    MDR report key: 2073125 · Received March 25, 2011

    Report

    Report Number
    3023750-2011-01046
    Event Type
    Malfunction
    Date Received
    March 25, 2011
    Report Date
    March 8, 2011
    Manufacturer
    WELCH ALLYN PROTOCOL, INC
    Product Code
    MKJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    PARAMEDIC

    Narratives

    Additional Manufacturer Narrative · 1

    THE PRODUCT HAS BEEN RECEIVED AND A FOLLOW-UP REPORT WILL BE PROVIDED WHEN OUR INVESTIGATION IS COMPLETED.

    Description of Event or Problem · 1

    COMPLAINANT ALLEGED THAT DURING A ROUTINE SHIFT CHECK BY A CLINICIAN, THE DEVICE POWERED ON WITHOUT DISPLAY AND PRIOR TO THE DISPLAY PROBLEM, THE DEVICE WAS UNABLE TO PACE. COMPLAINANT INDICATED THAT THERE WAS NO PT INVOLVEMENT IN THE REPORTED MALFUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PIC 50 AUTOMATED EXTERNAL DEFIB MKJ WELCH ALLYN PROTOCOL, INC PIC50 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NA