FDA Adverse Event Injury Summary report: N

CASSETTE MEDI RESERVOIR

MDR report key: 14800899 · Received June 23, 2022

Report

Report Number
MW5110486
Event Type
Injury
Date Received
June 23, 2022
Report Date
June 21, 2022
Manufacturer
SMITHS MEDICAL ASD, INC.
Product Code
LHI
Adverse Event
Yes
Product Problem
Yes
Report Source
Voluntary report
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Description of Event or Problem · 0

LAST WEEKEND, PATIENT HAD A NO DISPOSABLE PUMP WON'T RUN MALFUNCTION AND HER MOM HAD TO CALL 911 TO HAVE HER TAKEN TO THE ER BECAUSE SHE WAS HAVING CHANGES IN BREATHING. ONCE AT THE HOSPITAL SHE WAS ADMINISTERED INTRAVENOUS REMODULIN AND WAS DISCHARGED THE SAME CLAY. PATIENT WAS NEVER ADMITTED BUT WAS TREATED IN THE ER. SHE DID HAVE SOME HEADACHE AND LIGHT HEADEDNESS WHEN SHE RESTARTED, BUT SHE'S DOING WELL NOW. PATIENT'S MOM BELIEVES IT WAS A CASSETTE ISSUE SINCE THE SAME ISSUE HAPPENED WITH BOTH PUMP, BUT SHE WOULD FEEL BETTER WITH A REPLACEMENT FOR THE PUMP DUE 12/21/2022 [SERIAL (B)(4)] WHICH IS THE ONE PATIENT IS NOT CURRENTLY USING TO INFUSE. SHE WOULD FEEL BETTER HAVING A NEW ONE BECAUSE OF THIS EVENT. CASSETTE LOT NUMBER UNKNOWN. PHOTOGRAPHS WERE NOT PROVIDED. SET FLOW RATE AND VOLUME DELIVERED ARE UNKNOWN. POSITION OF THE PUMP WHEN ALARM OCCURRED IS UNKNOWN. THIS IS A CONTINUOUS INFUSION. NO FURTHER INFORMATION KNOWN. ALL KNOWN INFO IS CONTAINED ON THIS FORM. IF ANY ADD'L INFO IS RECEIVED, IT WILL BE PROVIDED ON A SEPARATE REPORT. PRODUCT EVENT IS FOR ONE PUMP AND ONE CASSETTE. DID THE REPORTED PRODUCT FAULT OCCUR WHILE IN USE WITH THE PT? YES; DID THE PRODUCT ISSUE CAUSE OR CONTRIBUTE TO PT OR CLINICAL INJURY? YES; IF YES, WAS ANY MEDICAL INTERVENTION PROVIDED? YES; PT WENT TO THE ER; IS THE ACTUAL CASSETTE AVAILABLE FOR INVESTIGATION? UNK; PUMP IS; DID WE REPLACE THE CASSETTE? YES AND PUMP; DID THE PT HAVE ADD'L CASSETTES THEY WERE ABLE TO SWITCH TO? NO; IF NO, WHAT WAS THE PT INSTRUCTED TO DO IN ABLE TO CONTINUE THEIR INFUSION? GO TO THER; IS THE INFUSION LIFE-SUSTAINING? YES; WHAT IS THE OUTCOME OF THE EVENT? RESOLVED. REPORTED TO (B)(6) BY PT/CAREGIVER.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
608908 CASSETTE MEDI RESERVOIR SET, I.V. FLUID TRANSFER LHI SMITHS MEDICAL ASD, INC.
608909 CADD PUMP PUMP, INFUSION LHI SMITHS MEDICAL ASD, INC. 6400 UNK

Patients

Seq Age Sex Outcome Treatment
1 Female