BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ALARIS

    MDR report key: 2172013 · Received July 13, 2011

    Report

    Report Number
    2172013
    Event Type
    Malfunction
    Date Received
    July 13, 2011
    Date of Event
    July 5, 2011
    Report Date
    July 13, 2011
    Manufacturer
    CAREFUSION
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    PA, US

    Narratives

    Description of Event or Problem · 1

    UPON RN WALKING IN PT ROOM, NOTED TOTAL PARENTERAL NUTRITION (TPN) TUBING ON THE FLOOR. HYPERALIMENTATION (HAL) TUBING HAD BECOME DISCONNECTED FROM THE LIPIDS AT THE Y SITE. LIPID TUBING STILL INTACT. GENERAL SURGERY NOTIFIED AND ORDERED APPROPRIATE IV FLUIDS TO START. HAL TUBING SAVED AND GIVEN TO UNIT DIRECTOR.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 10 MO