BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COLLEAGUE CX VOLUMETRIC INFUSION PUMP

    MDR report key: 1233083 · Received November 18, 2008

    Report

    Report Number
    6000001-2007-05962
    Event Type
    Malfunction
    Date Received
    November 18, 2008
    Date of Event
    April 1, 2007
    Report Date
    April 3, 2007
    Manufacturer
    BAXTER HEALTHCARE PTE. LTD.
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE FACILITY REPORTED AN INFUSION PUMP WITH A FAILURE CODE 814:04 CONDITION. EVALUATION SUMMARY: DURING PRODUCT EVALUATION, A DEFECTIVE AIL (AIR IN LINE) PCB (PRINTED CIRCUIT BOARD) WAS OBSERVED. FAILURE CODE 814:04 IN THE EVENT HISTORY CONFIRMS THE DEFECTIVE AIL PCB. THIS FAILURE CODE IS MANIFESTED AS A RESULT OF THE AIL PCB BEING DEFECTIVE. THE AIL PCB WAS REPLACED. REVIEW OF THE COMPLAINT HISTORY REVEALS SIMILAR REPORTS HAVE BEEN RECEIVED FOR THIS PRODUCT FOR THE REPORTED ISSUE. THIS ISSUE IS BEING INVESTIGATED.

    Description of Event or Problem · 1

    THE DEVICE WAS RETURNED TO BAXTER FOR SERVICE. DURING TESTING, THE BAXTER TECHNICIAN REPORTED AN INFUSION PUMP WITH AN AIL (AIR IN LINE) PCB (PRINTED CIRCUIT BOARD) MALFUNCTION. ACCORDING TO THE HOSPITAL REPRESENTATIVE, NO PATIENT INJURY OR MEDICAL INTERVENTION HAS BEEN REPORTED RELATED TO THIS DEVICE. NO ADDITIONAL INFORMATION IS KNOWN.

    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