BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIFEVEST WCD 4000 SYSTEM

    MDR report key: 2220525 · Received July 18, 2011

    Report

    Report Number
    3008642652-2011-00233
    Event Type
    Malfunction
    Date Received
    July 18, 2011
    Date of Event
    June 24, 2011
    Report Date
    July 15, 2011
    Manufacturer
    ZOLL LIFECOR CORPORATION
    Product Code
    MVK
    PMA / PMN Number
    P010030
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE EVAL SUMMARY: DEVICE EVAL OF BATTERY CHARGER/MODEM (B)(4) HAS BEEN COMPLETED. THE REPORTED PROBLEM (CHARGER/MODEM NOT POWERING UP) HAS BEEN CONFIRMED. UPON EVAL THE POWER BRICK CONNECTOR PIN WAS PUSHED INTO THE CONNECTOR, CAUSING THE CHARGER/MODEM TO FAIL TO POWER UP. THE ROOT CAUSE FOR THE DAMAGED CONNECTOR CANNOT BE POSITIVELY DETERMINED, BUT WAS LIKELY A RESULT OF EXCESSIVE FORCE. NO ADVERSE EVENT RESULTED FROM THE EFFECTIVE POWER BRICK CONNECTOR PIN. THE PT RECEIVED A REPLACEMENT BATTERY CHARGER/MODEM.

    Description of Event or Problem · 1

    A (B)(6) MALE PT CONTACTED ZOLL CUSTOMER SUPPORT TO REPORT THAT THE BATTERY CHARGER/MODEM DIDN'T APPEAR TO BE GETTING POWER. THE PT WAS ISSUED A REPLACEMENT BATTERY CHARGER/MODEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIFEVEST WCD 4000 SYSTEM WEARABLE CARDIOVERTER DEFIBRILLATOR MVK ZOLL LIFECOR CORPORATION WCD 4000 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR