BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HEARTSINE SAMARITAN 300P AND PAD PAK

    MDR report key: 4085544 · Received August 11, 2014

    Report

    Report Number
    3004123209-2014-00893
    Event Type
    Malfunction
    Date Received
    August 11, 2014
    Date of Event
    July 30, 2014
    Report Date
    August 1, 2014
    Manufacturer
    HEARTSINE TECHNOLOGIES, LTD
    Product Code
    MKJ
    PMA / PMN Number
    K041067
    Removal / Correction Number
    Z-0124-2013
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    THERE WAS A PT INVOLVED IN THIS EVENT. THIS DEVICE WAS USED IN A SUCCESSFUL SCA EVENT WHERE PT SURVIVED, HAS BEEN SELF-ACTIVATING AND DID NOT RECORD SCA EVENT DUE TO THE MEMORY OF THE UNIT BEING FULL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    475017 HEARTSINE SAMARITAN 300P AND PAD PAK AUTOMATED EXTERNAL DEFIBRILLATOR MKJ HEARTSINE TECHNOLOGIES, LTD PAD

    Patients

    Seq Age Sex Outcome Treatment
    1 87 YR