BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INTERNAL PADDLES OPTION FOR DEFIBRILLATOR/MONITOR

    MDR report key: 2190127 · Received June 30, 2011

    Report

    Report Number
    1218950-2011-01883
    Event Type
    Malfunction
    Date Received
    June 30, 2011
    Report Date
    June 6, 2011
    Manufacturer
    PHILIPS HEALTHCARE - ANDOVER
    Product Code
    MKJ
    PMA / PMN Number
    K031187
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). THE CUSTOMER REPORTED THAT THE INTERNAL PADDLE SET FAILED. THERE WAS NO NEGATIVE PT IMPACT RELATED TO THE FAILURE. THIS COMPLAINT IS STILL BEING INVESTIGATED. A FOLLOW-UP REPORT WILL BE SUBMITTED UPON COMPLETION OF THE INVESTIGATION.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT THE INTERNAL PADDLE SET FAILED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INTERNAL PADDLES OPTION FOR DEFIBRILLATOR/MONITOR MKJ PHILIPS HEALTHCARE - ANDOVER M4742A

    Patients

    Seq Age Sex Outcome Treatment
    1