FDA Adverse Event
Malfunction
Summary report: N
STOCKERT SYSTEM 3 ROLLER PUMP MODULE
MDR report key: 183724
·
Received August 24, 1998
Report
- Report Number
- 2022323-1998-00024
- Event Type
- Malfunction
- Date Received
- August 24, 1998
- Date of Event
- June 22, 1998
- Report Date
- August 24, 1998
- Manufacturer
- STOCKERT INSTRUMENTE
- Product Code
- DWB
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- PA, US
- Reporter Occupation
- OTHER
Narratives
Description of Event or Problem · 1
ON 08/03/1998 IT WAS REPORTED THAT AN SIII ARTERIAL PUMP STOPPED TWO TIMES. THE SYS WAS REBOOTED IN EACH CASE AND THE PUMP RESTARTED AND THE CASE CONTINUED WITHOUT FURTHER INCIDENT. NO PT INJURY.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | STOCKERT SYSTEM 3 ROLLER PUMP MODULE | STOCKERT SYSTEM 3 SINGLE HEAD ROLLER PUMP | DWB | STOCKERT INSTRUMENTE | 10-60-00 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | UNKNOWN | Required Intervention |