MAUDE Adverse Event Report: ZOLL MANUFACTURING CORPORATION LIFEVEST WCD 4000 SYSTEM; WEARABLE CARDIOVERTER DEFIBRILLATOR

Model Number WCD 4000

Device Problem Communication or Transmission Problem (2896)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 03/25/2020

Event Type  malfunction  

Manufacturer Narrative

The electrode belt sn (b)(4) was returned and evaluated at the distributor in accordance with zoll manufacturing recommendations.Upon investigation the electrode belt was found to have an open white (drvn_grnd) wire in the trunk cable.The trunk cable showed signs of physical abuse.The root cause for the open wire was excessive force.No adverse event resulted from the defective electrode belt.

Event Description

A us distributor reported that a patient's electrode belt was unable to communicate with a monitor.

• Brand Name: LIFEVEST WCD 4000 SYSTEM
• Type of Device: WEARABLE CARDIOVERTER DEFIBRILLATOR
• Manufacturer (Section D): ZOLL MANUFACTURING CORPORATION; 121 gamma drive; pittsburgh, pa
• Manufacturer (Section G): ZOLL MANUFACTURING CORPORATION; 121 gamma drive; pittsburgh, pa
• Manufacturer Contact: matthew saich ; 121 gamma drive; pittsburgh, pa ; 9683333
• MDR Report Key: 10414113
• MDR Text Key: 203713456
• Report Number: 3008642652-2020-06687
• Device Sequence Number: 1
• Product Code: MVK
• UDI-Device Identifier: 00855778005135
• UDI-Public: 00855778005135
• 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: 08/03/2020

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: Lay User/Patient
• Device Model Number: WCD 4000
• Device Catalogue Number: 10A1025
• Was Device Available for Evaluation?: Yes
• Initial Date Manufacturer Received: 07/28/2020
• Initial Date FDA Received: 08/17/2020
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 11/06/2015
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1