BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HEARTSINE SAMARITAN 300P AND PAD PAK

    MDR report key: 2915281 · Received December 19, 2012

    Report

    Report Number
    3004123209-2012-00422
    Event Type
    Malfunction
    Date Received
    December 19, 2012
    Date of Event
    November 19, 2012
    Report Date
    December 11, 2012
    Manufacturer
    HEARTSINE TECHNOLOGIES, LTD
    Product Code
    MKJ
    PMA / PMN Number
    K052465
    Removal / Correction Number
    Z-0124-2013
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    ROUTINE TESTING CONFIRMED THAT THIS DEVICE WAS INSTALLED BY THE CUSTOMER IN (B)(6) 2008. THE INFO OBTAINED FROM THE DEVICE SHOWED THAT ON (B)(6) 2011, A NEW PAD-PAK WAS INSTALLED AFTER WHICH, THE DEVICE PERFORMED TO SPECIFICATION UP TO (B)(6) 2012. THERE IS EVIDENCE OF MULTIPLE MANUAL POWER-UPS, THE DURATION OF WHICH ARE UNDER ONE MINUTE, WHICH INDICATES THAT THE DEVICE MAY BE MANUALLY TURNED ON AND OFF. INVESTIGATION CONFIRMED THERE TO BE NO FAULT WITH THE DEVICE OR ANY COMPONENT IN THE DEVICE. FURTHERMORE, THERE IS NO EVIDENCE FROM THE HISTORY OF THE DEVICE OR TESTING OF THE DEVICE, TO SHOW THAT IT WAS SWITCHING ITSELF ON AUTOMATICALLY AS REPORTED. THE PAD PAK, WHICH CONTAINS THE ELECTRODES AND BATTERIES, IS LABELED FOR SINGLE USE, BUT THE SAMARITAN PAD 300 AND 300P DEVICES ARE FOR MULTI-USE.

    Description of Event or Problem · 1

    THERE WAS NO PT INVOLVED IN THIS EVENT. THIS DEVICE MALFUNCTIONED BECAUSE IT WAS SWITCHING ITSELF ON AUTOMATICALLY. A DEVICE SWITCHING ITSELF ON AUTOMATICALLY, IF LEFT UNDETECTED COULD RESULT IN THE BATTERY BECOMING DEPLETED.

    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