BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LIFEVEST WCD 4000 SYSTEM

    MDR report key: 4733926 · Received April 23, 2015

    Report

    Report Number
    3008642652-2015-02355
    Event Type
    Injury
    Date Received
    April 23, 2015
    Date of Event
    March 10, 2014
    Report Date
    April 16, 2015
    Manufacturer
    ZOLL MANUFACTURING CORP
    Product Code
    MVK
    PMA / PMN Number
    P010030
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THERE WAS NO DEATH OR DEVICE MALFUNCTION ASSOCIATED WITH THE INAPPROPRIATE DEFIBRILLATION EVENT. THERE IS NO INDICATION OF A SERIOUS INJURY. DEVICE EVALUATION OF MONITOR SN (B)(4) AND BELT SN (B)(4) WAS COMPLETED. THE MONITOR AND ELECTRODE BELT WERE FUNCTIONAL AND ABLE TO DETECT AND TREAT. DEVICE MFG DATE: MONITOR: 05/01/2012 - REUSE, ELECTRODE BELT: 11/01/2009 - REUSE. INAPPROPRIATE DEFIBRILLATIONS ARE AN ANTICIPATED RISK ASSOCIATED WITH THE USE OF THE LIFEVEST. PTS ARE INSTRUCTED THROUGH ALARMS, VOICE MESSAGES, IFU, AND TRAINING TO PRESS THE RESPONSE BUTTONS TO PREVENT AN INAPPROPRIATE DEFIBRILLATION. (B)(4).

    Description of Event or Problem · 1

    DURING A RETROACTIVE REVIEW OF PAST TREATMENT EVENTS FOR POTENTIAL ADVERSE EVENTS, CONDUCTED AS A CAPA IN RESPONSE TO A RECENT FDA INSPECTION, A REPORTABLE ADVERSE EVENT WAS DISCOVERED. THE NIECE OF A (B)(6) MALE PT REPORTED THAT THE PT WAS TREATED. THE LIFEVEST DELIVERED TWO INAPPROPRIATE TREATMENTS AT 06:13:33 AND 06:13:55 DURING ATRIAL FIBRILLATION. THE RAPID ATRIAL FIBRILLATION CONTRIBUTED TO THE FALSE DETECTION. THE PT WAS CONSCIOUS RESPONSE BUTTONS WERE PRESSED INTERMITTENTLY, BUT NOT IMMEDIATELY PRIOR TO THE TREATMENTS. IT IS UNK IF THE PT SOUGHT MEDICAL ATTENTION. THE PT CONTINUED TO USE THE LIFEVEST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    269728 LIFEVEST WCD 4000 SYSTEM WEARABLE CARDIOVERTER DEFIBRILLATOR MVK ZOLL MANUFACTURING CORP WCD 4000 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Other