BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    8100 ALARIS PUMP MODULE

    MDR report key: 10895204 · Received November 24, 2020

    Report

    Report Number
    2016493-2020-46155
    Event Type
    Malfunction
    Date Received
    November 24, 2020
    Report Date
    October 16, 2018
    Manufacturer
    CAREFUSION SD
    Product Code
    FRN
    UDI-DI
    10885403810015
    PMA / PMN Number
    K133532
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 1

    THIS REPORTED EVENT AND SUBSEQUENT REPAIRS WERE INVESTIGATED THROUGH THE TSC TROUBLESHOOTING PROCESS. A REVIEW OF THE DEVICE SERVICE HISTORY RECORD WAS PERFORMED FROM THE DATE OF MANUFACTURE TO THE DATE CORRESPONDING TO THIS SERVICE NOTIFICATION NUMBER. THE DATABASE SHOWED NO QUALITY NOTIFICATIONS WERE OPENED FOR THE DEVICE. A REVIEW OF THE DEVICE HISTORY RECORD IN SAP FOR SN (B)(4) WAS PERFORMED FROM THE DATE OF THE MANUFACTURE TO DATE OF THE RELEASE OF PRODUCT, WHICH CONFIRMED THAT THIS DEVICE WAS NOT INVOLVED IN A PRODUCTION FAILURE, AND PRODUCT WAS RETURNED FOR SERVICING WHICH CORRELATES TO THE CUSTOMER REPORTED ISSUE. A TRACKWISE COMPLAINT HISTORY REVIEW WAS COMPLETED, AND IT WAS CONFIRMED THAT THERE WERE ADDITIONAL COMPLAINTS RECEIVED WITH SIMILAR SN (B)(4) FOR THE SAME OR RELATED FAILURE MODE. THE CUSTOMER STATED THAT THERE WAS NO PATIENT INVOLVEMENT.

    Description of Event or Problem · 1

    (B)(4). CASE COMPLETE. CUSTOMER CALLED IN WITH ERROR 211-2000 ON 8100 UNIT. WHICH IS UNSPECIFIED COMMUNICATION ERROR, THE LOGIC BOARD. WHICH IS THE MAIN BOARD ON THE UNIT AND WILL HAVE TO BE REPLACE. I CONFIRM TO CUSTOMER THE PART NUMBER FOR LOGIC BOARD. (B)(4). 8100 UNIT. SERIAL # (B)(4). CUSTOMER CALLED IN FOR HELP ON ERROR CODE 211-2000 ON 8100 UNIT WHICH IS UNSPECIFIED COMMUNICATION ERROR, WILL HAVE TO REPLACE THE LOGIC BOARD ON UNIT. CUSTOMER ASK WEATHER ITS CHEAPER FOR HIM TO GET THE BOARD OR SEND IN FOR SERVICES REPAIR. CONFIRM PART PRICE WITHOUT TAXES, AND ALSO CONFIRM TO CUSTOMER LEVEL 1 & LEVEL 2 QUOTE. CUSTOMER WILL CALL BACK ONCE HE IS READY TO SEND UNIT IN FOR SERVICES REPAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1361662 8100 ALARIS PUMP MODULE PUMP, INFUSION FRN CAREFUSION SD 8100 10885403810015

    Patients

    Seq Age Sex Outcome Treatment
    1