FDA Adverse Event Malfunction Summary report: N

HEARTSINE SAMARITAN 300P AND PAD-PAK

MDR report key: 7817978 · Received August 27, 2018

Report

Report Number
3004123209-2018-00557
Event Type
Malfunction
Date Received
August 27, 2018
Date of Event
August 1, 2018
Report Date
November 29, 2018
Manufacturer
HEARTSINE TECHNOLOGIES LTD
Product Code
MKJ
PMA / PMN Number
K014067
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
SG
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

THE DEVICE HISTORY RECORDS FOR THE SAM 300P DEVICE AND PAD-PAK WERE REVIEWED AND THIS CONFIRMED THAT ALL MANUFACTURING AND QUALITY CHECKS AND TEST HAD BEEN SUCCESSFULLY COMPLETED. THE SAM 300P PASSED ¿OUT QAT FROM HEARTSINE TECHNOLOGIES ON THE 18TH JULY 2014. THE DEVICE WAS RETURNED WITH THE REPORTED FAULT ¿RED STATUS INDICATOR¿. DURING TESTING AT HEARTSINE, THE RED STATUS INDICATOR WAS OBSERVED TO BE FLASHING ALONG WITH THE LEFT PAD PLACEMENT LED. THE FAULT WAS TRACED BACK TO A FAILURE IN THE MEMBRANE DUE TO A BREAKDOWN IN THE CROSS-OVER INSULATION RESULTING IN LEAKAGE CURRENT BETWEEN TRACK 1 (STATUS_LED_RED) AND TRACK 2 (LEFT_PAD_LED). THIS WOULD EXPLAIN THE RED STATUS LED AND LEFT PAD LED FLASHING SIMULTANEOUSLY DURING THE POWER UP. THE FAULT COULD NOT BE REPLICATED WITH A NEW MEMBRANE FITTED. IT IS THE POLICY OF HEARTSINE NOT TO REFURBISH DEVICES WHICH HAVE BEEN RETURNED FROM THE FIELD, AFTER INVESTIGATION, THEREFORE THIS DEVICE SHALL BE SCRAPPED AND REPLACED WITH A SAM 350P.

Additional Manufacturer Narrative · 0

EXEMPTION NUMBER E2015058. HEARTSINE TECHNOLOGIES LTD (MANUFACTURER) IS SUBMITTING THE REPORT ON BEHALF OF HEARTSINE TECHNOLOGIES LLC (IMPORTER).

Description of Event or Problem · 0

RED STATUS INDICATOR FLASHING. NO PATIENT INVOLVED.

Description of Event or Problem · 0

RED STATUS INDICATOR FLASHING. NO PATIENT INVOLVED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
662233 HEARTSINE SAMARITAN 300P AND PAD-PAK AUTOMATED EXTERNAL DEFIBRILLATOR MKJ HEARTSINE TECHNOLOGIES LTD

Patients

Seq Age Sex Outcome Treatment
1