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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ZOLL MEDICAL CORPORATION R SERIES; DEFIBRILLATOR/PACEMAKER

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ZOLL MEDICAL CORPORATION R SERIES; DEFIBRILLATOR/PACEMAKER Back to Search Results
Model Number 30001004101110012
Medical Device Problem Code Intermittent Loss of Power (4016)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event Malfunction
Event or Problem Description
Complainant alleged that during biomed testing, the device would intermittently not power up.Complainant indicated that there was no patient involvement in the reported malfunction.
 
Additional Manufacturer Narrative
Zoll medical corporation has received the product and will be providing a supplemental report when our investigation is completed.
 
Additional Manufacturer Narrative
The device was returned to zoll medical corporation.During the investigation it was noted that the reported issue regarding the device intermittently not powering on was verified during our evaluation.It was found that the ac charger was at fault and was replaced to remedy the issue.Further evaluation of the ac charger did not determine the root cause, and the ac charger was scrapped.No emerging trend based on similar reports.
 
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Brand Name
R SERIES
Common Device Name
DEFIBRILLATOR/PACEMAKER
Manufacturer (Section D)
ZOLL MEDICAL CORPORATION
269 mill road
chelmsford MA 01824
Manufacturer Contact
scott august
269 mill road
chelmsford, MA 01824
9784219552
MDR Report Key24313341
Report Number1220908-2026-00393
Device Sequence Number5583518
Product Code MKJ
UDI-Device Identifier00847946017439
UDI-Public(01)00847946017439
Combination Product (Y/N)N
Initial Reporter StateIN
Initial Reporter CountryUS
PMA/510(K) Number
P160022
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Initial Reporter Occupation Other
Type of Report Initial,Followup
Report Date (Section B) 01/22/2026
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 Number30001004101110012
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer02/10/2026
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 01/22/2026
Supplement Date Received by ManufacturerNot provided
Initial Report FDA Received Date02/11/2026
Supplement Report FDA Received Date03/14/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured03/01/2021
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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