BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIFEVEST WCD 4000 SYSTEM

    MDR report key: 4939752 · Received July 24, 2015

    Report

    Report Number
    3008642652-2015-04622
    Event Type
    Malfunction
    Date Received
    July 24, 2015
    Date of Event
    July 1, 2015
    Report Date
    July 24, 2015
    Manufacturer
    ZOLL MANUFACTURING CORPORATION
    Product Code
    MVK
    PMA / PMN Number
    P010030
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE EVALUATION OF MONITOR SN (B)(4) HAS BEEN COMPLETED. THE REPORTED PROBLEM (RESETS) WAS CONFIRMED. UPON EVALUATION THE MONITOR WAS RESETTING DURING PULSE TESTING. THE ROOT CAUSE FOR THE RESETS WAS ISOLATED TO NOISE FROM THE DEFIBRILLATOR PCA HIGH-VOLTAGE CAPACITORS PROPAGATING ON THE MAIN BATTERY WIRE ON THE MONITOR C/A BOARD. PMA SUPPLEMENT P010030/S064 WAS SUBMITTED TO FDA ON 07/06/2015 AND IS CURRENTLY UNDER REVIEW. NO ADVERSE EVENT RESULTED FROM THE DEFECTIVE MONITOR.

    Description of Event or Problem · 1

    A US DISTRIBUTOR RETURNED MONITOR SN (B)(4) AND REPORTED THAT THE MONITOR WAS RESETTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    483382 LIFEVEST WCD 4000 SYSTEM WEARABLE CARDIOVERTER DEFIBRILLATOR MVK ZOLL MANUFACTURING CORPORATION WCD 4000

    Patients

    Seq Age Sex Outcome Treatment
    1