BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BD ALARIS PUMP INFUSION SET- BACK CHECK VALVE

    MDR report key: 16664474 · Received March 31, 2023

    Report

    Report Number
    MW5116222
    Event Type
    Injury
    Date Received
    March 31, 2023
    Date of Event
    March 24, 2023
    Report Date
    March 29, 2023
    Manufacturer
    BECTON DICKINSON AND COMPANY
    Product Code
    FPA
    UDI-DI
    07613203020992
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE
    Health Professional
    Yes

    Narratives

    Description of Event or Problem · 0

    MED SURG RN DISCONNECTED A PRIMARY INTRAVENOUS TUBING LINE FROM THE MEDI-PORT CONNECTION PORT EXERTING REGULAR EFFORT. THE TIP OF THE PRIMARY TUBING LINE BROKE OFF AND GOT STUCK IN THE CONNECTION HUB. PRIMARY RN HAD TO REPLACE THE MEDI-PORT ACCESS TO ENSURE THAT THE PORT CAN BE INFUSED WITH MEDICATION AND NO PLASTIC FRAGMENTS WERE LEFT THAT CAN COMPROMISE CLEANLINESS OF THE CONNECTION. CENTRAL SUPPLY MANAGER AND RISK MANAGEMENT MADE AWARE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1250952 BD ALARIS PUMP INFUSION SET- BACK CHECK VALVE SET, ADMINISTRATION, INTRAVASCULAR FPA BECTON DICKINSON AND COMPANY 2426-0500 (10)23013192 07613203020992

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Female Required Intervention