FDA Adverse Event
Malfunction
Summary report: N
HEART START XL
MDR report key: 2170822
·
Received June 22, 2011
Report
- Report Number
- 1218950-2011-01797
- Event Type
- Malfunction
- Date Received
- June 22, 2011
- Report Date
- May 26, 2011
- Manufacturer
- PHILIPS HEALTHCARE - ANDOVER
- Product Code
- MKJ
- PMA / PMN Number
- K001725
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IN
- Reporter Occupation
- UNKNOWN
Narratives
Additional Manufacturer Narrative · 1
(B)(4). THE CUSTOMER REPORTED A FAILURE TO DISCHARGE DURING TESTING VIA INTERNAL PADDLES. THE DEVICE AND PADDLES SET WERE EVALUATED LOCALLY BY PHILIPS. THE PROBLEM WAS ISOLATED TO A BROKEN PIN ON THE INTERNAL PADDLES. REPLACEMENT OF THE INTERNAL PADDLE SET RESOLVED THE SYMPTOM.
Description of Event or Problem · 1
THE CUSTOMER REPORTED A FAILURE TO DISCHARGE DURING TESTING VIA INTERNAL PADDLES.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | HEART START XL | MKJ | PHILIPS HEALTHCARE - ANDOVER | M4735A |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |