FDA Adverse Event Malfunction Summary report: N

HEARTSINE GATEWAY 500P BUNDLE SALES BOM - UK ENGLISH

MDR report key: 21252373 · Received January 28, 2025

Report

Report Number
3004123209-2025-00022
Event Type
Malfunction
Date Received
January 28, 2025
Date of Event
January 3, 2025
Report Date
December 18, 2025
Manufacturer
HEARTSINE TECHNOLOGIES LTD
Product Code
MKJ
PMA / PMN Number
P160008
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
UK
Reporter Occupation
003

Narratives

Additional Manufacturer Narrative · 0

SECTION G1 REPORTING ENTITY OF SUPPLEMENTAL MDR INDICATES: PHYSIO-CONTROL, INC. - 3015876 SECTION G1 REPORTING ENTITY OF SUPPLEMENTAL MDR SHOULD INDICATE: HEARTSINE TECHNOLOGIES LTD SECTION G1 MANUFACTURING SITE FOR DEVICES OF SUPPLEMENTAL MDR INDICATES: PHYSIO-CONTROL, INC. - 3015876 SECTION G1 MANUFACTURING SITE FOR DEVICES OF SUPPLEMENTAL MDR SHOULD INDICATE: HEARTSINE TECHNOLOGIES LTD.

Additional Manufacturer Narrative · 0

THE CUSTOMER'S DEVICE WAS RETURNED FOR THE EVALUATION. A SERVICE REPRESENTATIVE WAS ABLE TO DUPLICATE THE REPORTED ISSUE. A CAUSE OF THE REPORTED ISSUE COULD NOT BE DETERMINED.

Additional Manufacturer Narrative · 0

THE CUSTOMER'S DEVICE WAS NOT RETURNED FOR EVALUATION. A CAUSE OF THE REPORTED ISSUE COULD NOT BE DETERMINED.

Additional Manufacturer Narrative · 0

HEARTSINE HAS REQUESTED RETURN OF THE DEVICE FOR INVESTIGATION. UPON COMPLETION, THE CONCLUSIONS WILL BE SUBMITTED IN A FOLLOW-UP REPORT. THE PAD-PAK-03 DEVICE IS NOT AVAILABLE FOR DISTRIBUTION IN THE UNITED STATES BUT IS SIMILAR TO THE PAD-PAK-01 WHICH IS DISTRIBUTED IN THE UNITED STATES.

Description of Event or Problem · 0

THE CUSTOMER CONTACTED HEARTSINE TO REPORT THAT THEIR PAD-PAK WAS DEPLETED BEFORE EXPIRY AND COULD NOT POWER ON ANY SAM PAD DEVICES. IN THIS STATE THE DEVICE WOULD BE INOPERABLE AND DEFIBRILLATION THERAPY WOULD NOT BE AVAILABLE IF NEEDED. THERE WAS NO PATIENT INVOLVEMENT REPORTED WITH THE EVENT.

Description of Event or Problem · 0

THE CUSTOMER CONTACTED HEARTSINE TO REPORT THAT THEIR PAD-PAK WAS DEPLETED BEFORE EXPIRY AND COULD NOT POWER ON ANY SAM PAD DEVICES. IN THIS STATE THE DEVICE WOULD BE INOPERABLE AND DEFIBRILLATION THERAPY WOULD NOT BE AVAILABLE IF NEEDED. THERE WAS NO PATIENT INVOLVEMENT REPORTED WITH THE EVENT.

Description of Event or Problem · 0

THE CUSTOMER CONTACTED HEARTSINE TO REPORT THAT THEIR PAD-PAK WAS DEPLETED BEFORE EXPIRY AND COULD NOT POWER ON ANY SAM PAD DEVICES. IN THIS STATE THE DEVICE WOULD BE INOPERABLE AND DEFIBRILLATION THERAPY WOULD NOT BE AVAILABLE IF NEEDED. THERE WAS NO PATIENT INVOLVEMENT REPORTED WITH THE EVENT.

Description of Event or Problem · 0

THE CUSTOMER CONTACTED HEARTSINE TO REPORT THAT THEIR PAD-PAK WAS DEPLETED BEFORE EXPIRY AND COULD NOT POWER ON ANY SAM PAD DEVICES. IN THIS STATE THE DEVICE WOULD BE INOPERABLE AND DEFIBRILLATION THERAPY WOULD NOT BE AVAILABLE IF NEEDED. THERE WAS NO PATIENT INVOLVEMENT REPORTED WITH THE EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2376764 HEARTSINE GATEWAY 500P BUNDLE SALES BOM - UK ENGLISH AUTOMATED EXTERNAL DEFIBRILLATORS (NON-WEARABLE) MKJ HEARTSINE TECHNOLOGIES LTD PAD-PAK-03 H1108

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown