MAUDE Adverse Event Report: PHILIPS NORTH AMERICA LLC HS1 DEFIBRILLATOR, FRENCH, EXCHANGE; AED

Model Number M5066A

Device Problem Premature Discharge of Battery (1057)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Type  malfunction  

Event Description

It has been reported that the device will not power on.

• Brand Name: HS1 DEFIBRILLATOR, FRENCH, EXCHANGE
• Type of Device: AED
• Manufacturer (Section D): PHILIPS NORTH AMERICA LLC; 22100 bothell everett highway; bothell WA 98021
• Manufacturer (Section G): PHILIPS NORTH AMERICA LLC; 22100 bothell everett highway; bothell WA 98021
• Manufacturer Contact: tinievangeline petty ; 22100 bothell everett highway; bothell, WA 98021 ; 9095703538
• MDR Report Key: 15028727
• MDR Text Key: 296050141
• Report Number: 3030677-2022-03507
• Device Sequence Number: 1
• Product Code: MKJ
• UDI-Device Identifier: 00884838049123
• UDI-Public: 00884838049123
• Combination Product (y/n): N
• Reporter Country Code: FR
• PMA/PMN Number: P160029
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Distributor
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 07/15/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Other
• Device Model Number: M5066A
• Device Catalogue Number: 453564428221
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 06/30/2022
• Initial Date FDA Received: 07/15/2022
• Supplement Dates Manufacturer Received: 08/08/2022
• Supplement Dates FDA Received: 08/12/2022
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 06/01/2015
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1