| Brand Name | AUTOPULSE®RESUSCITATION SYSTEM |
| Common Device Name | CARDIAC RESUSCITATOR, LINE-POWERED |
| Manufacturer (Section D) |
| ZOLL CIRCULATION, INC |
| 2000 ringwood ave |
| san jose CA 95131 |
|
| Manufacturer (Section G) |
| ZOLL CIRCULATION, INC |
| 2000 ringwood ave |
|
| san jose CA 95131 |
|
| Manufacturer Contact |
|
kimthoa
sackrison
|
| 2000 ringwood ave |
| san jose, CA 95131
|
|
| MDR Report Key | 23069735 |
| Report Number | 3010617000-2025-00629 |
| Device Sequence Number | 18641104 |
| Product Code |
DRM
|
| Combination Product (Y/N) | N |
| Initial Reporter Country | GM |
| PMA/510(K) Number | K112998 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Health Professional,User Facility,Company Representative |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/16/2025 |
| 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 | 100 |
| Device Catalogue Number | 8700-0700-01 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 08/22/2025 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/26/2025 |
| Initial Report FDA Received Date | 09/16/2025 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 03/03/2016 |
| 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 |