BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BAXTER

    MDR report key: 218078 · Received April 2, 1999

    Report

    Report Number
    218078
    Event Type
    Injury
    Date Received
    April 2, 1999
    Date of Event
    March 29, 1999
    Report Date
    April 2, 1999
    Manufacturer
    BAXTER HEALTHCARE CORP. I.V. SYSTEMS DIV.
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    GA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    3-CHANNEL INFUSION PUMP FAILURE. IT ALARMED ONCE, OPENED ALL LINES & SHUT ITSELF OFF. NURSE IN ROOM AT TIME OF EVENT. MEDICATIONS INVOLVED WERE: DOPAMINE, DOBUTREX, LEVOPHED, AND N.S. W/KCL & MGS04.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BAXTER INFUSION PUMP FRN BAXTER HEALTHCARE CORP. I.V. SYSTEMS DIV. COLLEAGUE 3 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR Life Threatening