FDA Adverse Event
Injury
Summary report: N
CADD
MDR report key: 11801570
·
Received May 10, 2021
Report
- Report Number
- 3012307300-2021-04165
- Event Type
- Injury
- Date Received
- May 10, 2021
- Date of Event
- April 7, 2021
- Report Date
- May 10, 2021
- Manufacturer
- ST PAUL
- Product Code
- FRN
- UDI-DI
- 10610586029554
- PMA / PMN Number
- K051568
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- PA, US
- Reporter Occupation
- OTHER HEALTH CARE PROFESSIONAL
Narratives
Description of Event or Problem · 1
INFORMATION RECEIVED A SMITHS MEDICAL AMBULATORY INFUSION PUMPS/CADD MS3 PUMPS UNDER INFUSED AS THE PATIENT HER CASSETTE WAS STILL FULL AFTER 24 HOURS OF INFUSION. PATIENT RECEIVES : REMODULIN MDV 5MG/ML, DOSE OR AMOUNT: 45.62 NG/KG/MIN FOR PULMONARY ARTERIAL HYPERTENSION. SHE HAD NOTIFIED DOCTOR AND NURSE, SHE WAS INSTRUCTED BY THEM THAT SHE SHOULD GO TO HOSPITAL IF SHE SHOULD BECOME SYMPTOMATIC AND CONDITION WORSENS. PATIENT HAD A BACK UP PUMP SHE SUCCESSFULLY SWITCHED TO. HOWEVER, PATIENT REPORTED TO BE SYMPTOMATIC FEELING CLAMMY AND LOUSY. TIME LAPSE OF UNDER INFUSION MAY HAVE CONTRIBUTED TO EVENT. MEDICATION IS LIFE SUSTAINING. THE EVENT WAS ISOLATED TO A PUMP ISSUE AND NOT CASSETTE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 699115 | CADD | MS3 SLATE | FRN | ST PAUL | 7400 | 10610586029554 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 58 YR |