BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HOME PUMP

    MDR report key: 14812 · Received July 21, 1994

    Report

    Report Number
    MW1002913
    Event Type
    Malfunction
    Date Received
    July 21, 1994
    Date of Event
    July 12, 1994
    Report Date
    July 13, 1994
    Manufacturer
    BLOCK MEDICAL, INC.
    Product Code
    MEB
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    DC, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT WAS INFUSING A DOSE OF ZINACEF VIA PUMP WHEN A LARGE LEAK STARTED FROM THE IN-LINE FILTER. PT STOPPED INFUSION AND MISSED ONE DOSE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOME PUMP HOME PUMP MEB BLOCK MEDICAL, INC. E102000 41403

    Patients

    Seq Age Sex Outcome Treatment
    1 25 YR Other