BEUDAMED
    FDA Adverse Event Death Summary report: N

    KONTRON AIR AMBULANCE TRANSPORT

    MDR report key: 10812 · Received December 13, 1993

    Report

    Report Number
    10812
    Event Type
    Death
    Date Received
    December 13, 1993
    Date of Event
    November 19, 1993
    Report Date
    December 1, 1993
    Manufacturer
    KONTRON INSTRUMENTS, INC.
    Product Code
    DSP
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    RI, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PT LEFT HOSP IN PRIVATE AMBULANCE TO TRANSPORT TO ANOTHER HOSP AT 10:15 PM FULLY CHARGED (14V). EN ROUTE, INFUSION PUMP WAS PLUGGED IN BUT FAILED SO MANUAL INFUSION PROCEEDED. AT 10:35 PM, THE BATTERY ON THE INTRA-AORTIC BALLOON PUMP INDICATED THERE WAS 20 MINUTES REMAINING. MINUTES LATER, THE SAME BATTERY INDICATED THERE WAS 10 MINUTES REMAINING. THE RN PLUGGED IN THE IABP INTO THE AMBULANCE'S ELECTRICAL OUTLET WHEN ALL THE POWER IN THE AMBULANCE WENT OUT. AS THE PT WAS TOTALLY DEPENDFENT ON THE BALLOON PUMP, THE PT WAS TAKEN TO ANOTHER HOSP WHERE HE DIED AFTER ACLS. THE PT WAS PRONOUNCED AT 11:23 PM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KONTRON AIR AMBULANCE TRANSPORT INTRA-AORTIC BALLOON PUMP DSP KONTRON INSTRUMENTS, INC. 9020202T

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Death A.V.I. PUMP FAILED