BEUDAMED
    FDA Adverse Event Summary report: N

    SECONDARY MEDICATION SET

    MDR report key: 2051526 · Received March 18, 2011

    Report

    Report Number
    2051526
    Date Received
    March 18, 2011
    Date of Event
    March 18, 2011
    Report Date
    March 18, 2011
    Manufacturer
    BAXTER HEALTHCARE CORPORATION
    Product Code
    FPA
    Report Source
    User Facility report
    Reporter Location
    RI, US

    Narratives

    Description of Event or Problem · 1

    MEDICATION HUNG VIA SECONDARY TUBING WAS ADMINISTERED VIA GRAVITY-FLOW. MEDICATION WAS NOT DRIPPING (PRIMARY BAG INFUSED). TUBING WAS CHANGED AND SECONDARY MEDICATION INFUSED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SECONDARY MEDICATION SET IV TUBING, SECONDARY MEDICATION SET FPA BAXTER HEALTHCARE CORPORATION 2C7461 07-34-52-308

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR