BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HOSPIRA SYMBIQ PUMP

    MDR report key: 1990004 · Received February 9, 2011

    Report

    Report Number
    MW5019382
    Event Type
    Malfunction
    Date Received
    February 9, 2011
    Date of Event
    February 1, 2011
    Report Date
    February 9, 2011
    Manufacturer
    HOSPIRA INC
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MD, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PT WAS RECEIVING IV FLUID THAT WAS ORDERED TO BE STARTED WITHIN HALF AN HR. IV PUMP WAS STARTED AT 2:21 PM AND SAID THAT IT WAS INFUSING. PUMP LATER ALARMED APPROX 1 HR AND 15 MINUTES LATER. ONLY 5 ML OF IV FLUID HAD INFUSED DURING THAT TIME. PUMP WAS PROGRAMMED FOR SODIUM BICARB AT 250 ML PER HOUR X 2 HOURS AT THE TIME. THIS WAS TO BE COMPLETED BEFORE UA CHECK AND CHEMO ADMINISTRATION. PUMP WAS PLACED OUT OF SERVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOSPIRA SYMBIQ PUMP NONE FRN HOSPIRA INC

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR