Brand Name | LIFEVEST WCD 4000 SYSTEM |
Type of Device | WEARABLE CARDIOVERTER DEFIBRILLATOR |
Manufacturer (Section D) |
ZOLL MANUFACTURING CORPORATION |
121 gamma drive |
pittsburgh PA 15238 3495 |
|
Manufacturer (Section G) |
ZOLL MANUFACTURING CORPORATION |
121 gamma drive |
|
pittsburgh PA 15238 3495 |
|
Manufacturer Contact |
mallory
boocks
|
121 gamma drive |
pittsburgh, PA 15238-3495
|
4129683333
|
|
MDR Report Key | 11100500 |
MDR Text Key | 224551234 |
Report Number | 3008642652-2020-11656 |
Device Sequence Number | 1 |
Product Code |
MVK
|
UDI-Device Identifier | 00855778005005 |
UDI-Public | 00855778005005 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P010030 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
12/31/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Lay User/Patient
|
Device Model Number | WCD 4000 |
Device Catalogue Number | 10A0988 |
Initial Date Manufacturer Received |
12/28/2020
|
Initial Date FDA Received | 12/31/2020 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
Required Intervention;
|