BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INTERMATE

    MDR report key: 2103047 · Received May 25, 2011

    Report

    Report Number
    6000001-2011-04630
    Event Type
    Malfunction
    Date Received
    May 25, 2011
    Date of Event
    May 1, 2011
    Report Date
    May 6, 2011
    Manufacturer
    BAXTER HEALTHCARE - IRVINE
    Product Code
    FRN
    PMA / PMN Number
    K910425
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). DEVICE EVALUATION: ONE SAMPLE WAS RECEIVED BY BAXTER FOR EVALUATION. VISUAL EXAMINATION AND FUNCTIONAL TESTING OF THE UNIT DID NOT CONFIRM THE LEAK. THIS IS A SINGLE USE DEVICE AND WILL NOT BE REPAIRED. NO OTHER OBSERVATION WAS FOUND ON THE UNIT. A BATCH REVIEW WAS CONDUCTED AND NO ISSUES WERE FOUND RELATED TO THE REPORTED CONDITION DURING THE MANUFACTURE OF THE LOT. BAXTER HAS CONDUCTED A TREND REVIEW AND FOUND THAT SIMILAR REPORTS HAVE BEEN RECEIVED FOR THE REPORTED PROBLEM. THE ROOT CAUSE WAS NOT IDENTIFIED. BAXTER WILL CONTINUE TO MONITOR SIMILAR REPORTS TO DETERMINE IF FURTHER ACTIONS ARE REQUIRED.

    Additional Manufacturer Narrative · 1

    (B)(4). ADDITIONAL NARRATIVE: PER THE CUSTOMER, THIS DEVICE IS NOT AVAILABLE FOR EVALUATION. THEREFORE, THE RESULTS OF EVALUATION COULD NOT BE COMPLETED AND THE REPORTED CONDITION COULD NOT BE CONFIRMED. SHOULD THE DEVICE AND/OR ANY ADDITIONAL INFORMATION BECOME AVAILABLE, A FOLLOW-UP REPORT WILL BE SUBMITTED

    Description of Event or Problem · 1

    BAXTER CANADA RECEIVED A REPORT INVOLVING THE CE INTERMATE DEVICE. THE QUALITY SPECIALIST REPORTED THAT THERE WAS A LEAK FROM BLUE WINGED LUER CAP, FOUND AFTER COMPOUNDING, CONTAINS PAMIDRONATE. THE PROCESS STEP WAS BEFORE USE, THEREFORE THERE WAS NO PATIENT INVOLVEMENT. THIS WILL REFERENCE REPORT 2 OF 2 FOR THE FACILITY, AS THE FACILITY REPORTED 2 DEVICES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INTERMATE PUMP, INFUSION FRN BAXTER HEALTHCARE - IRVINE 11A039

    Patients

    Seq Age Sex Outcome Treatment
    1 PAMIDRONATE