FDA Adverse Event Other Summary report: N

CURLIN 4000CMS AMBULATORY INFUSION PUMP

MDR report key: 1471377 · Received September 10, 2009

Report

Report Number
1722139-2009-00030
Event Type
Other
Date Received
September 10, 2009
Date of Event
August 12, 2009
Report Date
September 9, 2009
Manufacturer
CURLIN MEDICAL
Product Code
FRN
Removal / Correction Number
2031921-2008-001-C
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
SC, US
Reporter Occupation
NOT APPLICABLE

Narratives

Additional Manufacturer Narrative · 1

THE PUMP WAS RETURNED TO MOOG MEDICAL DEVICES GROUP AND WAS RECEIVED ON 08/13/2009 AND CONSEQUENTLY EVALUATED. A VISUAL EXAMINATION AND A VOLUMETRIC ACCURACY TEST CONFIRMED THAT THE PLATEN/DOOR LATCH WAS BENT/DAMAGED, WHICH RESULTS FROM BEING DROPPED. RESULTS: THE PUMP BEING DROPPED DIRECTLY CAUSED THE PLATEN/DOOR LATCH TO BEND, THIS CAUSING THE OVERINFUSION. CONCLUSIONS: THE BENT PLATEN LIKELY CONTRIBUTED DIRECTLY TO THE EVENT. REFERENCE FIELD CORRECTION TRACKING NUMBER: 2031921-2008-001-C.

Description of Event or Problem · 1

PUMP OVER INFUSED PHENTANYL CITRATE (B) (6). ANESTHESIOLOGIST NOTICED THAT THE BAG WAS EMPTYING FASTER THAN IT SHOULD. DETAILS PROVIDED BY STAFF RN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 CURLIN 4000CMS AMBULATORY INFUSION PUMP FRN CURLIN MEDICAL 350-1100 NONE

Patients

Seq Age Sex Outcome Treatment
1