BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COLLEAGUE 3 VOLUMETRIC INFUSION PUMP

    MDR report key: 1170166 · Received September 24, 2008

    Report

    Report Number
    6000001-2007-03530
    Event Type
    Malfunction
    Date Received
    September 24, 2008
    Date of Event
    January 9, 2007
    Report Date
    January 9, 2007
    Manufacturer
    BAXTER HEALTHCARE PTE. LTD.
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THIS REPORT IS BEING RESUBMITTED IN ACCORDANCE WITH INSTRUCTIONS FROM FDA TO ADDRESS A MANUFACTURER REPORT SEQUENCE NUMBER ISSUE THAT OCCURRED WHEN THIS MDR OR SUPPLEMENT WAS ORIGINALLY SUBMITTED TO THE FDA ON JAN 30 2007. EVALUATION SUMMARY: THE CONDITION OF FAILURE CODE 812:02 ON CHANNEL A WAS CONFIRMED DURING PRODUCT EVALUATION. THIS FAILURE CODE WAS CAUSED BY A FAULTY PUMP HEAD MECHANISM. PUMP HEAD MECHANISM CHANNEL A WAS THEREFORE REPLACED.

    Description of Event or Problem · 1

    FAILURE CODE 812:02 OCCURRED ON CHANNEL A DURING PRODUCT EVALUATION. THERE WAS NO PATIENT INJURY OR MEDICAL INTERVENTION NECESSARY ACCORDING TO THE HOSPITAL REPRESENTATIVE. NO ADDITIONAL INFORMATION IS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COLLEAGUE 3 VOLUMETRIC INFUSION PUMP INFUSION PUMP FRN BAXTER HEALTHCARE PTE. LTD. NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1