FDA Adverse Event Death Summary report: N

PHYSIO CONTROL

MDR report key: 3666 · Received June 30, 1992

Report

Report Number
3666
Event Type
Death
Date Received
June 30, 1992
Date of Event
January 25, 1992
Report Date
March 3, 1992
Manufacturer
PHYSIO CONTROL
Product Code
MGD
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

PATIENT HAD A PERMANENT PACEMAKER WHICH LOST CAPTURE. RESUSCITATION BEGAN. TRANSTHORACIC PACEMAKER APPLIED, PACER CASSETTE FAILED TO COME ON. PERMANENT PACEMAKER BEGAN TO CAPTURE. PATIENT EXPIRED. IT IS NOT FELT FAILED PACER CASSETTE CONTRIBUTED TO DEATH OF PATIENT. HOWEVER, FAILURE OF THIS TYPE HAS THE POTENTIAL TO CONTRIBUTE TO DEATH OF A PATIENT AND IS THEREFORE BEING REPORTED.DEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: CRITICAL CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: 01-NOV-91. SERVICE PROVIDED BY: USER FACILITY BIOMEDICAL/BIOENGINEERING DEPARTMENT. SERVICE RECORDS AVAILABLE.INVALID DATA - REGARDING WHETHER EVENT PRESENTS IMMINENT HAZARD. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, ELECTRICAL TESTS PERFORMED, MECHANICAL TESTS PERFORMED, PERFORMANCE TESTS PERFORMED, VISUAL EXAMINATION. RESULTS OF EVALUATION: ELECTRICAL PROBLEM - OPEN CIRCUIT. CONCLUSION: DEVICE FAILED JUST PRIOR TO USE. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: DEVICE RETURNED TO MANUFACTURER/DEALER/DISTRIBUTOR. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PHYSIO CONTROL QUICK-PACE CASSETTE MGD PHYSIO CONTROL LP-8

Patients

Seq Age Sex Outcome Treatment
1 81 YR Death