FDA Adverse Event Death Summary report: N

LIFEPAK 9P

MDR report key: 798 · Received June 26, 1992

Report

Report Number
798
Event Type
Death
Date Received
June 26, 1992
Date of Event
June 11, 1992
Report Date
June 16, 1992
Manufacturer
PHYSIO - CONTROL
Product Code
DRK
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

PATIENT HAD CARDIAC ARREST IN ROOM. DURING RESUSCITATION EFFORTS, LIFEPAK 9P WAS USED. MA WOULD NOT ADJUST, THEREFORE EXTERNAL PACEMAKER WOULD NOT CAPTURE. REPLACEMENT LIFEPAK 9P IMMEDIATELY OBTAINED FROM ANOTHER NURSING UNIT AND USED ON PATIENT. PATIENT EXPIRED. INQUIRES MADE OF PHYSCIAN DURING COMMITTEE INVESTIGATION OF INCIDENT AS TO EFFECT OF EQUIPMENT FAILURE ON OUTCOME OF CODE. PHYSCIAN SATES EVENT WAS UNRELATED TO OUTCOMEDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: CRITICAL CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: 01-MAR-92. SERVICE PROVIDED BY: INDEPENDENT FACTORY TRAINED/AUTHORIZED SERVICE ORGANIZATION. SERVICE RECORDS AVAILABLE.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, ELECTRICAL TESTS PERFORMED, PERFORMANCE TESTS PERFORMED. RESULTS OF EVALUATION: COMPONENT FAILURE, OTHER. CONCLUSION: DEVICE FAILURE OCCURRED BUT NOT RELATED TO EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: NO. CORRECTIVE ACTIONS: DEVICE PERMANENTLY REMOVED FROM SERVICE, DEVICE RETURNED TO MANUFACTURER/DEALER/DISTRIBUTOR. THE DEVICE WAS NOT DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 LIFEPAK 9P DEFIBRILLATOR W/ MONITOR AND PACEMAKER DRK PHYSIO - CONTROL 9P N/A

Patients

Seq Age Sex Outcome Treatment
1 74 YR Death