BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HEARTSTART ONSITE

    MDR report key: 2824187 · Received October 24, 2012

    Report

    Report Number
    3030677-2012-01391
    Event Type
    Malfunction
    Date Received
    October 24, 2012
    Report Date
    July 30, 2012
    Manufacturer
    PHILIPS MEDICAL SYSTEMS
    Product Code
    MKJ
    PMA / PMN Number
    020715
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). DEVICE EVAL PENDING. DATE OF MANUFACTURE 07/2012.

    Description of Event or Problem · 1

    IT HAS BEEN REPORTED THAT DEVICE DID NOT PASS A SELF DIAGNOSTIC CHECK. NO ASSOCIATED DEPLOYMENT OF DEVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HEARTSTART ONSITE MKJ PHILIPS MEDICAL SYSTEMS M5066A

    Patients

    Seq Age Sex Outcome Treatment
    1