BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ALARIS PUMP MODULE MEDLEY GEMINI 3 VALVE

    MDR report key: 2220449 · Received August 17, 2011

    Report

    Report Number
    MW5021806
    Event Type
    Injury
    Date Received
    August 17, 2011
    Date of Event
    August 17, 2011
    Report Date
    August 17, 2011
    Manufacturer
    ALARIS
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    IV PUMP TUBING INFUSION INSULIN RUPTURED AT CASSETTE CONNECTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ALARIS PUMP MODULE MEDLEY GEMINI 3 VALVE IV PUMP TUBING FPA ALARIS

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Required Intervention