FDA Adverse Event Malfunction Summary report: N

ALARIS SYSTEM

MDR report key: 16465743 · Received March 2, 2023

Report

Report Number
2016493-2023-121580
Event Type
Malfunction
Date Received
March 2, 2023
Date of Event
February 8, 2023
Report Date
December 26, 2023
Manufacturer
CAREFUSION SD
Product Code
FRN
UDI-DI
10885403424267
PMA / PMN Number
K133532
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
VA, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

A DEVICE HISTORY RECORD REVIEW IS PERFORMED ON EACH DEVICE REPORTED IN A MDR REPORTABLE EVENT ALONG WITH OTHER METHODS OF INVESTIGATION AS CODED IN SECTION H6 OF THIS MDR REPORT. PER 803.52(F)(11)(III) THE INFORMATION PROVIDED WAS OBTAINED FROM SERVICING ACTIVITIES PERFORMED ON THE DEVICE. THERE WERE NO ADDITIONAL DETAILS OBTAINABLE OR PROVIDED AT THE TIME OF SERVICE. H3 OTHER TEXT : SEE MANUFACTURER NARRATIVE

Additional Manufacturer Narrative · 0

A DEVICE HISTORY RECORD REVIEW IS PERFORMED ON EACH DEVICE REPORTED IN A MDR REPORTABLE EVENT ALONG WITH OTHER METHODS OF INVESTIGATION AS CODED IN THIS MDR REPORT. PER 803.52(F)(11)(III), THE INFORMATION PROVIDED WAS OBTAINED FROM SERVICING ACTIVITIES PERFORMED ON THE DEVICE. THERE WERE NO ADDITIONAL DETAILS OBTAINABLE OR PROVIDED AT THE TIME OF SERVICE.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE DEVICE HAD SOFTWARE FAULT AND READS 13-1033-149. THERE WAS NO PATIENT INVOLVEMENT.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE DEVICE HAD SOFTWARE FAULT AND READS 13-1033-149. THERE WAS NO PATIENT INVOLVEMENT.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE DEVICE HAD SOFTWARE FAULT AND READS 13-1033-149. THERE WAS NO PATIENT INVOLVEMENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
453358 ALARIS SYSTEM PUMP, INFUSION FRN CAREFUSION SD 8110 10885403424267

Patients

Seq Age Sex Outcome Treatment
1 Unknown