BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COLLEAGUE CX VOLUMETRIC INFUSION PUMP

    MDR report key: 1172403 · Received September 25, 2008

    Report

    Report Number
    6000001-2007-00599
    Event Type
    Malfunction
    Date Received
    September 25, 2008
    Date of Event
    December 4, 2006
    Report Date
    December 4, 2006
    Manufacturer
    BAXTER HEALTHCARE PTE. LTD.
    Product Code
    FRN
    Removal / Correction Number
    6000001-3/15/05-007-C
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, 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. EVALUATION SUMMARY: THE CONDITION OF FAIL CODE 810: 11 WAS OBSERVED IN THE EVENT HISTORY DURING PRODUCT EVALUATION. THIS DEVICE WAS EVALUATED AT THE CUSTOMER'S FACILITY IN LATE 2006. THIS FAIL CODE WAS DUE TO A FAULTY PUMP HEAD MODULE. THE PUMP HEAD MODULE WAS REPLACED.

    Description of Event or Problem · 1

    THE BAXTER FIELD SERVICE ENGINEER NOTED AN INFUSION PUMP WITH FAILURE CODE 810:11 IN THE EVENT HISTORY WHILE SERVICING THIS DEVICE. THE HOSPITAL REPRESENTATIVE STATED THAT THERE WERE NO REPORTS OF PATIENT INJURY OR MEDICAL INTERVENTION. NO ADDITIONAL INFORMATION IS AVAILABLE.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1