FDA Adverse Event Malfunction Summary report: N

8015 ALARIS SYSTEM PC UNIT

MDR report key: 16046242 · Received December 26, 2022

Report

Report Number
2016493-2022-1179037
Event Type
Malfunction
Date Received
December 26, 2022
Report Date
October 20, 2019
Manufacturer
CAREFUSION SD
Product Code
FRN
UDI-DI
10885403801518
PMA / PMN Number
K133532
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

ADDITION: UPDATED ADVERSE EVENT CODES (H6).

Additional Manufacturer Narrative · 0

NOTE: THIS EVENT WAS INADVERTENTLY REPORTED UNDER INCORRECT PRODUCT REGISTRATION NUMBER (MANUFACTURER REPORT NUMBER 9616066-2020-02923). THIS MDR RESUBMISSION NOW REFLECTS THE CORRECT PRODUCT REGISTRATION NUMBER. THE CUSTOMER REPORTED PROBLEM WAS CONFIRMED. THE DEVICE WAS REPAIRED, RETESTED AND RETURNED TO THE CUSTOMER. INFUSION PRODUCTS GLOBAL CUSTOMER SUPPORT OPERATIONS. A REVIEW OF THE DEVICE HISTORY RECORD IN SAP FOR SN 13835043 WAS PERFORMED FROM THE DATE OF THE MANUFACTURE TO DATE OF THE RELEASE OF PRODUCT, WHICH CONFIRMED THAT THIS DEVICE WAS NOT INVOLVED IN A PRODUCTION FAILURE, AND PRODUCT WAS RETURNED FOR SERVICING WHICH CORRELATES TO THE CUSTOMER REPORTED ISSUE. A TRACKWISE COMPLAINT HISTORY REVIEW WAS COMPLETED, AND IT WAS CONFIRMED THAT THERE WERE ADDITIONAL COMPLAINTS RECEIVED WITH SIMILAR SN (B)(4)FOR THE SAME OR RELATED FAILURE MODE. THE CUSTOMER STATED THAT THERE WAS NO PATIENT INVOLVEMENT.

Description of Event or Problem · 0

UNIT DUE FOR 2YR BATTERY CHANGE- 10/20/2019 20:39:53 (B)(6) - UNIT DUE FOR 2YR BATTERY CHANGE THERE WAS NO PATIENT INVOLVEMENT.

Description of Event or Problem · 0

UNIT DUE FOR 2YR BATTERY CHANGE- 10/20/2019 20:39:53 VICTOR CABRERA (VCABRERA) - UNIT DUE FOR 2YR BATTERY CHANGE. THERE WAS NO PATIENT INVOLVEMENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
441911 8015 ALARIS SYSTEM PC UNIT PUMP, INFUSION FRN CAREFUSION SD 8015 ALARIS PCU 1.5 MODULE 10885403801518

Patients

Seq Age Sex Outcome Treatment
1 Unknown