FDA Adverse Event Death Summary report: N

LIFE PAK 5

MDR report key: 569 · Received May 12, 1992

Report

Report Number
569
Event Type
Death
Date Received
May 12, 1992
Date of Event
April 6, 1992
Report Date
April 23, 1992
Manufacturer
PHYSIO-CONTROL
Product Code
DRK
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

ON APRIL 6, 1992, OUR SQUAD RESPONDED TO A CARDIAC FAILURE. THE PATIENT WAS DEFIBRILLATED THREE TIMES, ONCE AT 200 AND TWICE AT 300. THE TECHNICIAN INCREASED TO 360 AND ATTEMPTED A FORTH TIME. AT THAT TIME THE APEX PADDLE FLASHED A WHITE LIGHT AND MADE A LOUD NOISE. THE DEFIBRILLATOR COULD NOT BE TURNED ON. THERE WAS TOTAL LOSS OF POWER. A SECOND LIFE-PAK WAS THEN UTILIZED. AFTER EACH DEFIBRILLATION THE PATIENT'S EKG MONITOR NEVER DISPLAYED A NORMAL COMPLEX, INDICATING THAT SHE WAS NOT RESPONDING TO RESUSCITATION ATTEMPTSINVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: INVALID DATA. INVALID DATA - REGARDING MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. INVALID DATA - REGARDING WHETHER EVENT PRESENTS IMMINENT HAZARD. INVALID DATA - WHETHER DEVICE USED AS LABELED/INTENDED. INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: UNKNOWN (CANNOT DETERMINE). CORRECTIVE ACTIONS: NO DATA. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 LIFE PAK 5 DEFIBRILLATOR DRK PHYSIO-CONTROL LIFE PAK 5

Patients

Seq Age Sex Outcome Treatment
1 Death