BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    8100 ALARIS PUMP MODULE

    MDR report key: 11129826 · Received January 7, 2021

    Report

    Report Number
    2016493-2021-02878
    Event Type
    Malfunction
    Date Received
    January 7, 2021
    Report Date
    January 22, 2020
    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

    THE CUSTOMER REPORTED PROBLEM WAS CONFIRMED. THE DEVICE WAS REPAIRED, RETESTED, AND RETURNED TO THE CUSTOMER. 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 REVIEW OF THE COMPLAINT HISTORY RECORD IN THE TRACKWISE WAS PERFORMED FOR THE SN (B)(4) WHICH CONFIRMED NO SIMILAR COMPLAINTS WITH THE SAME OR RELATED FAILURE MODE. THE CUSTOMER STATED THAT THERE WAS NO PATIENT INVOLVEMENT.

    Description of Event or Problem · 1

    ALARM - ERROR CODES / MESSAGES LOGIC BOARD- CHIP PIN DAMAGE AND RECALL AFFECTED ALARM - ERROR CODES / MESSAGES- 01/22/2020 05:29:37 RFC_REPAIRS (RFC_REPAIRS) (B)(4). DOWNLOADED ERROR LOG. CONTAINS NUMEROUS CODES. TECH SERVICE RECOMMENDED REPLACING MOTOR CONTROL AND POWER SUPPLY BOAR DS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    30277 8100 ALARIS PUMP MODULE PUMP, INFUSION FRN CAREFUSION SD 8100 10885403810015

    Patients

    Seq Age Sex Outcome Treatment
    1