BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIFEVEST WCD 4000 SYSTEM

    MDR report key: 4232410 · Received September 17, 2014

    Report

    Report Number
    3008642652-2014-02887
    Event Type
    Malfunction
    Date Received
    September 17, 2014
    Date of Event
    August 22, 2014
    Report Date
    September 16, 2014
    Manufacturer
    ZOLL MANUFACTURING CORPORATION
    Product Code
    MVK
    PMA / PMN Number
    P010030
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE EVALUATION OF ELECTRODE BELT SN (B)(4) HAS BEEN COMPLETED. THE REPORTED PROBLEM (FAILED INCOMING FUNCTIONALITY TESTING) HAS BEEN CONFIRMED. AS RECEIVED, THE BELT FAILED INCOMING FUNCTIONALITY TESTING. UPON EVAL, THE CONNECTOR WAS CUT OFF THE TRUNK CABLE. THE CAUSE OF THE INCOMING TEST FAILURE WAS THE SEVERED TRUNK CABLE CONNECTOR. THE ROOT CAUSE OF THE DAMAGED TRUNK CABLE WAS UNABLE TO BE POSITIVELY IDENTIFIED BUT IS LIKELY DUE TO PHYSICAL ABUSE. NO ADVERSE EVENT RESULTED FROM THE DAMAGED BELT.

    Description of Event or Problem · 1

    A US DISTRIBUTOR CONTACTED ZOLL TO REPORT THAT ELECTRODE BELT SN (B)(4) DID NOT PASS INCOMING FUNCTIONALITY TESTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    575189 LIFEVEST WCD 4000 SYSTEM WEARABLE CARDIOVERTER DEFIBRILLATOR MVK ZOLL MANUFACTURING CORPORATION WCD 4000 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NA