BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HOSPIRA

    MDR report key: 1080838 · Received July 22, 2008

    Report

    Report Number
    MW5007742
    Event Type
    Malfunction
    Date Received
    July 22, 2008
    Date of Event
    July 18, 2008
    Report Date
    July 22, 2008
    Manufacturer
    HOSPIRA
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    OMNI PUMP ST FOR CHEMOTHERAPY TREATMENT. TUBING CONNECTED THEN UNCLAMPED FOR ABOUT 5 MINS WHEN THE RN NOTICED AN ARCHING SPRAY COMING FROM THE LINE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOSPIRA MED LENGTH SECONDARY IV SET FPA HOSPIRA 60314 4W

    Patients

    Seq Age Sex Outcome Treatment
    1