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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: PHYSIO-CONTROL, INC. - 3015876 LIFEPAK 1000 DEFIBRILLATOR; AUTOMATED EXTERNAL DEFIBRILLATORS (NON-WEARABLE)

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PHYSIO-CONTROL, INC. - 3015876 LIFEPAK 1000 DEFIBRILLATOR; AUTOMATED EXTERNAL DEFIBRILLATORS (NON-WEARABLE) Back to Search Results
Model Number 1000
Medical Device Problem Code Failure to Power Up (1476)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 07/04/2024
Type of Reportable Event Malfunction
Event or Problem Description
The customer contacted stryker to report that their device will not power on.There was no report of patient use associated with the reported event.
 
Additional Manufacturer Narrative
Stryker evaluated the customer's device and verified the reported issue.The device was returned to the customer and stryker recommended that the customer obtain a replacement device.The cause of the reported issue could not be determined.
 
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Brand Name
LIFEPAK 1000 DEFIBRILLATOR
Common Device Name
AUTOMATED EXTERNAL DEFIBRILLATORS (NON-WEARABLE)
Manufacturer (Section D)
PHYSIO-CONTROL, INC. - 3015876
11811 willows road ne
redmond WA 98052
Manufacturer (Section G)
PHYSIO-CONTROL, INC. - 3015876
11811 willows road ne
redmond WA 98052
Manufacturer Contact
brian blakeslee
11811 willows road ne
redmond, WA 98052
4258674000
MDR Report Key19917014
Report Number0003015876-2024-02337
Device Sequence Number8346033
Product Code MKJ
UDI-Device Identifier00883873815458
UDI-Public00883873815458
Combination Product (Y/N)N
Initial Reporter StateNY
Initial Reporter CountryUS
PMA/510(K) Number
K122600
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source User Facility
Initial Reporter Occupation Non-Healthcare Professional
Type of Report Initial
Report Date (Section B) 08/06/2024
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 Lay User/Patient
Device Model Number1000
Device Catalogue Number99425-000023
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer07/09/2024
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 07/08/2024
Initial Report FDA Received Date08/06/2024
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured04/20/2012
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 Number1
Patient SexUnknown
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