MAUDE Adverse Event Report: CARDIAC SCIENCE CORPORATION G3, AED, AHA 2010, US ENGLISH, TSO; AUTOMATED EXTERNAL DEFIBRILATOR

Model Number	9300E-1001-TSO
Medical Device Problem Code	Unable to Obtain Readings (1516)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Event or Problem Description
Complainant alleged that during functional testing, the device was unable to obtain an ecg signal via electrode pads.Complainant indicated that there was no patient involvement in the reported malfunction.
Additional Manufacturer Narrative
Zoll medical corporation has not received the device for evaluation and this complaint is still under investigation.
Additional Manufacturer Narrative
The device and pads were not returned to zoll medical corporation for evaluation.However, the customer's report was observed during the review of the provided device data logs.Without receipt of the device, component root cause analysis could not be established.Analysis of reports of this type has not identified an increase in trend.
Additional Manufacturer Narrative
The device was returned to zoll medical corporation for evaluation.The customer's report was observed during review of the device data logs.However, the device was put through extensive testing incuding on/off current testing, patient/ circuit impedance testing and shock testing without duplicating the report.An internal inspection of the device found no discrepancies.The main board was replaced as a precaution.The device was recertified and returned to the customer.Analysis of reports of this type has not identified an increase in trend.

• Brand Name: G3, AED, AHA 2010, US ENGLISH, TSO
• Common Device Name: AUTOMATED EXTERNAL DEFIBRILATOR
• Manufacturer (Section D): CARDIAC SCIENCE CORPORATION; 500 burdick parkway; deerfield WI 53531 9692
• Manufacturer Contact: scott august ; 269 mill road; chelmsford, MA 01824 ; 9784219552
• MDR Report Key: 16872739
• Report Number: 2112020-2023-00382
• Device Sequence Number: 20282614
• Product Code: MKJ
• UDI-Device Identifier: 00812394020201
• UDI-Public: 00812394020201
• Combination Product (Y/N): N
• Initial Reporter Country: TU
• PMA/510(K) Number: P160033
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 04/13/2023

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
• Operator of Device: Other
• Device Model Number: 9300E-1001-TSO
• Device Catalogue Number: 9300E-1001-TSO
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/13/2023
• Supplement Date Received by Manufacturer: 04/13/2023; 04/13/2023
• Initial Report FDA Received Date: 05/04/2023
• Supplement Report FDA Received Date: 06/10/2023; 07/13/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/21/2015
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown