BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HOSPIRA LIFESHIELD SYMBIQ PUMP 150 ML BURETTE SET

    MDR report key: 1843536 · Received September 20, 2010

    Report

    Report Number
    MW5017550
    Event Type
    Injury
    Date Received
    September 20, 2010
    Date of Event
    July 31, 2010
    Report Date
    September 20, 2010
    Manufacturer
    HOSPIRA
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    PHARMACIST

    Narratives

    Description of Event or Problem · 1

    THE LIFESHIELD SYMBIQ PUMP 150 ML BURRETTE SET -HOSPIRA LIST NUMBER 16014-01- HAD A DEFECT. THE BAG SPIKE SEPARATED FROM THE TUBING AND THE ENTIRE CONTENTS OF A NEONATAL TPN WAS SPILLED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOSPIRA LIFESHIELD SYMBIQ PUMP 150 ML BURETTE SET NEONATAL BURETTE FPA HOSPIRA 690365H

    Patients

    Seq Age Sex Outcome Treatment
    1 5 DA Hospitalization