BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HEARTSINE SAMARITAN 300P AND PAD PAK

    MDR report key: 2892639 · Received December 20, 2012

    Report

    Report Number
    3004123209-2012-00814
    Event Type
    Malfunction
    Date Received
    December 20, 2012
    Date of Event
    November 28, 2010
    Report Date
    December 14, 2012
    Manufacturer
    HEARTSINE TECHNOLOGIES, LTD
    Product Code
    MKJ
    PMA / PMN Number
    K052465
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NL
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE PAD DEVICE WAS INSTALLED ON (B)(4) 2010 AND OPERATED SUCCESSFULLY UNTIL A FAILED SELF TEST ON (B)(4) 2010. THERE ARE SEVERAL MORE FAILED SELF TESTS DUE TO A LOW BATTERY. THE USER WAS ALERTED TO THE PROBLEM BY THE RED LED STATUS INDICATOR BEING ILLUMINATED AND AN AUDIBLE BEEP. ON INSPECTION OF THE PAD DEVICE, AN INCONSISTENT VOLTAGE MEASUREMENT WAS FOUND WHICH WOULD INDICATE A FAULT WITH THE POGO-PINS. . THE PAD PAK, WHICH CONTAINS THE ELECTRODES AND BATTERIES, IS LABELED FOR SINGLE USE BUT THE SAMARITAN PAD 300 AND 300P ARE FOR MULTI-USE.

    Description of Event or Problem · 1

    THERE WAS NO PT INVOLVED IN THIS EVENT. THIS DEVICE MALFUNCTIONED BECAUSE THE STATUS INDICATOR WAS FLASHING RED AND THE DEVICE WAS EMITTING A LOW BATTERY WARNING. A DEVICE IN THIS FAULT MODE, IF LEFT UNDETECTED, COULD RESULT IN THE FAILURE OF THE DEVICE TO PERFORM AS INTENDED IF REQUIRED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HEARTSINE SAMARITAN 300P AND PAD PAK AUTOMATED EXTERNAL DEFIBRILLATOR MKJ HEARTSINE TECHNOLOGIES, LTD PAD

    Patients

    Seq Age Sex Outcome Treatment
    1