BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COLLEAGUE 3CX VOLUMETRIC INFUSION PUMP

    MDR report key: 1170758 · Received September 24, 2008

    Report

    Report Number
    6000001-2007-02318
    Event Type
    Malfunction
    Date Received
    September 24, 2008
    Date of Event
    December 30, 2006
    Report Date
    December 30, 2006
    Manufacturer
    BAXTER HEALTHCARE PTE. LTD.
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    BIOMEDICAL ENGINEER

    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 22 2007. EVALUATION SUMMARY: THE CONDITION OF A PUMP WITH FAILURE CODE 812:02 ON CHANNEL B WAS CONFIRMED IN THE PUMP'S EVENT HISTORY FILE DURING PRODUCT EVALUATION. THIS FAILURE CODE WAS CAUSED BY A FAULTY PUMP HEAD MECHANISM. PUMP HEAD MECHANISM CHANNEL B WAS THEREFORE REPLACED.

    Description of Event or Problem · 1

    DURING PRODUCT EVALUATION, FAILURE CODE 812:02 ON CHANNEL B WAS IDENTIFIED IN THE PUMP'S EVENT HISTORY FILE. 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 3CX VOLUMETRIC INFUSION PUMP INFUSION PUMP FRN BAXTER HEALTHCARE PTE. LTD. NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1