BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LIFEVEST WCD 4000 SYSTEM

    MDR report key: 4564916 · Received February 27, 2015

    Report

    Report Number
    3008642652-2015-00994
    Event Type
    Injury
    Date Received
    February 27, 2015
    Date of Event
    January 31, 2015
    Report Date
    February 25, 2015
    Manufacturer
    ZOLL MANUFACTURING CORP
    Product Code
    MVK
    PMA / PMN Number
    P010030
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THERE WAS NOT DEATH OR DEVICE MALFUNCTION ASSOCIATED WITH THE INAPPROPRIATE DEFIBRILLATION. THERE IS NO INFORMATION TO SUGGEST THAT THE PT SUSTAINED A SERIOUS INJURY. THE PT DID NOT SEEK MEDICAL ATTENTION AND CONTINUED USE OF THE LIFEVEST. DEVICE EVALUATION WAS ACCOMPLISHED THROUGH A REVIEW OF THE PT'S DOWNLOADED DATA FILE. REVIEW OF THE DATA DOES NOT INDICATE ANY DEVICE MALFUNCTION RELATED TO THE DEFIBRILLATION EVENT. MONITOR (B)(4): 10/2014 - REUSE, ELECTRODE BELT (B)(4): 09/2014 - INITIAL USE.

    Description of Event or Problem · 1

    A US DISTRIBUTOR CONTACTED ZOLL TO REPORT THAT A PT EXPERIENCED AN INAPPROPRIATE DEFIBRILLATION EVENT. MULTIPLE COUNTING CONTRIBUTED TO THE FALSE DETECTION. THE PT WAS REPORTEDLY CONSCIOUS AT THE TIME OF THE EVENT AND REPORTED THAT HE PRESSED THE RESPONSE BUTTONS. REVIEW OF THE PT'S DOWNLOADED DATA REVEALS THAT THE RESPONSE BUTTONS WERE PRESSED DURING AN EARLIER DETECTION, BUT NOT DURING THE DEFIBRILLATION EVENT. THE RESPONSE BUTTONS WERE ALSO FUNCTIONAL DURING THE SUBSEQUENT POWER ON SEQUENCE. THE RESPONSE BUTTONS FUNCTIONED APPROPRIATELY. THE PT DID NOT SEEK MEDICAL ATTENTION AND CONTINUED USE OF THE LIFEVEST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    140961 LIFEVEST WCD 4000 SYSTEM WEARABLE CARDIOVERTER DEFIBRILALTOR MVK ZOLL MANUFACTURING CORP WCD 4000 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Other