BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HEARTSTART HOME

    MDR report key: 7916192 · Received September 27, 2018

    Report

    Report Number
    3030677-2018-02157
    Event Type
    Malfunction
    Date Received
    September 27, 2018
    Report Date
    April 19, 2018
    Manufacturer
    PHILIPS MEDICAL SYSTEMS
    Product Code
    NSA
    PMA / PMN Number
    K040904
    Removal / Correction Number
    Z-0642-2013, Z-0643-2013
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    CORRECTED MANUFACTURE DATE FROM JULY 5, 2018 TO FEBRUARY 1, 2012.

    Description of Event or Problem · 1

    THE DEVICE WAS RETURNED WITH AN ERROR IN THE DATA LOG.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    755799 HEARTSTART HOME AED NSA PHILIPS MEDICAL SYSTEMS M5068A

    Patients

    Seq Age Sex Outcome Treatment
    1