BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ALARIS

    MDR report key: 1870783 · Received October 1, 2010

    Report

    Report Number
    1870783
    Event Type
    Malfunction
    Date Received
    October 1, 2010
    Date of Event
    October 23, 2010
    Report Date
    October 1, 2010
    Manufacturer
    CAREFUSION
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    PA, US

    Narratives

    Description of Event or Problem · 1

    PATIENT IV TUBING SPONTANEOUSLY DISCONNECTED FROM PATIENT. REPLACED. NO HARM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ALARIS SMARTSITE FPA CAREFUSION * *

    Patients

    Seq Age Sex Outcome Treatment
    1 3 WK