| Brand Name | LIFELINE |
| Common Device Name | AUTOMATED EXTERNAL DEFIBRILLATORS |
| Manufacturer (Section D) |
| DEFIBTECH, L.L.C. |
| 741 boston post rd. |
| suite 201 |
| guilford CT 06437 |
|
| Manufacturer (Section G) |
| DEFIBTECH, L.L.C. |
| 14 commercial st. |
|
| branford |
|
| Manufacturer Contact |
|
nissa
soto
|
| 741 boston post road |
| suite 201 |
| guilford, CT 06437
|
|
2034536654
|
|
| MDR Report Key | 25891234 |
| Report Number | 3003521780-2026-01129 |
| Device Sequence Number | 9956727 |
| Product Code |
MKJ
|
| UDI-Device Identifier | 00815098020195 |
| UDI-Public | (01)00815098020195 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | NL |
| PMA/510(K) Number | P160032 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | Unknown |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Consumer,Distributor |
| Initial Reporter Occupation |
Other
|
| Type of Report
| Initial |
| Report Date (Section B) |
07/21/2026 |
| 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
|
| Device Model Number | DDU-E2200 |
| Was Device Available for Evaluation? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 06/22/2026 |
| Initial Report FDA Received Date | 07/21/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 03/04/2021 |
| 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 |
Unknown
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|