MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-03-18 for ASSY,MAIH, 2.7 DIA, W/SWITCH, 100-120V ONLY 1011-0139-03 8011-0139-03 manufactured by Zoll Medical Corporation.
[70534765]
Zoll medical corporation has not received the device for evaluation and this complaint is still under investigation.
Patient Sequence No: 1, Text Type: N, H10
[70534766]
Complainant alleged that while attempting to treat a patient (age & gender unknown), the associated device failed to discharge using these internal handles. Complainant did not indicate that there was any adverse effect to the patient due to the reported malfunction.
Patient Sequence No: 1, Text Type: D, B5
[76442657]
This follow up medwatch report is reporting the evaluation of the device. This follow up medwatch report is also updating information submitted on the initial medwatch report. Evaluation results: the reported malfunction was observed and attributed to an open between pin 2 and pin 4; which is directly related to the discharge switch within the internal handles. The internal handles were scrapped. Analysis of reports of this type has not identified an increase in trend.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1220908-2017-00539 |
| MDR Report Key | 6415991 |
| Date Received | 2017-03-18 |
| Date of Report | 2017-02-27 |
| Date Mfgr Received | 2017-02-27 |
| Device Manufacturer Date | 2015-11-01 |
| Date Added to Maude | 2017-03-18 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Street | 269 MILL ROAD |
| Manufacturer City | CHELMSFORD MA 01824 |
| Manufacturer Country | US |
| Manufacturer Postal | 01824 |
| Manufacturer Phone | 9784219552 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ASSY,MAIH, 2.7 DIA, W/SWITCH, 100-120V ONLY |
| Generic Name | INTERNAL PADDLE |
| Product Code | LLD |
| Date Received | 2017-03-18 |
| Returned To Mfg | 2017-04-06 |
| Model Number | 1011-0139-03 |
| Catalog Number | 8011-0139-03 |
| Lot Number | NA |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ZOLL MEDICAL CORPORATION |
| Manufacturer Address | 269 MILL ROAD CHELMSFORD MA 01824 US 01824 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-03-18 |