BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    1600 SEM AUTOMATIC DEFIBRILLATOR

    MDR report key: 504470 · Received December 12, 2003

    Report

    Report Number
    1220908-2003-01941
    Event Type
    Malfunction
    Date Received
    December 12, 2003
    Date of Event
    November 21, 2003
    Report Date
    November 21, 2003
    Manufacturer
    ZOLL MEDICAL CORP.
    Product Code
    MKJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SD, US
    Reporter Occupation
    NOT APPLICABLE

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 1600 SEM AUTOMATIC DEFIBRILLATOR DEFIBRILLATOR MKJ ZOLL MEDICAL CORP. 1600 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR Other