FDA Adverse Event Malfunction Summary report: N

ALARIS SYSTEM

MDR report key: 22963494 · Received September 4, 2025

Report

Report Number
2016493-2025-110984
Event Type
Malfunction
Date Received
September 4, 2025
Date of Event
August 12, 2025
Report Date
December 8, 2025
Manufacturer
CAREFUSION SD
Product Code
FRN
UDI-DI
10885403810046
PMA / PMN Number
K211218
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
PA, US
Reporter Occupation
NURSE
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

A FOLLOW UP REPORT WILL BE SUBMITTED WITH INVESTIGATION RESULTS SHOULD THE DEVICE BE REPAIRED OR THE DEVICE/LOGS BE RECEIVED FOR EVALUATION. PER 803.52(F)(11)(III) THE INFORMATION PROVIDED REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. THE COMPLAINANT OR REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO THE MANUFACTURER.

Additional Manufacturer Narrative · 0

CORRECTION: IT WAS DETERMINED THROUGH INVESTIGATION OF THE RETURNED DEVICES THAT THE INITIALLY REPORTED SUSPECT DEVICE REPORTED UNDER MANUFACTURER REPORT NUMBER: 2016493-2025-110984 IS A CONCOMITANT. THE DEVICE WAS AFFECTED DUE TO THE ISSUE OBSERVED ON THE SUSPECT DEVICE CAPTURED IN MANUFACTURER REPORT NUMBER: 2016493-2025-111743.

Description of Event or Problem · 0

IT WAS REPORTED THAT THERE WAS AN UNDER INFUSION OF CEFTAROLINE (CEFTAROLINE 5.92 MG IN NSS 0.5 ML IVPB). THE ELECTRONIC MEDICAL RECORD (EMR) RECORDED ADMINISTRATION OF CEFTAROLINE, HOWEVER THE PATIENT DID NOT ACTUALLY RECEIVE THE MEDICATION. THE RATE, DATE/TIME SEEN IN THE EMR UNDER CEFTAROLINE IS THE RATE, DATE/TIME FOR THE INFUSION OF BLOOD (TRANSFUSE RBC) 14 ML. THE EVENT OCCURRED BETWEEN 0500-0800. THE RATES RECORDED IN THE EMR FOR CEFTAROLINE WAS ACTUALLY THE RATE OF THE BLOOD ACCORDING TO THE NURSE. 0528 ¿ 5 ML/HOUR, 0530 3.73 ML/HOUR, 0532 ¿ 4.91 ML/HOUR, 0600 ¿ 4.91 ML/HOUR, 0800 ¿ 4.91 ML/HOUR, 0821 ¿ NEW BAG, 0823 ¿ 1.5 ML/HOUR. THE BLOOD INFUSION WAS PROGRAMMED MANUALLY, THEY DID SCAN CEFTRAOLINE BUT IT IS NOT BUILT IN THE NEONATAL DRUG LIBRARY. CEFTRAOLINE DID ASSOCIATE TO THE PUMP FROM NIGHT¿S DOSE THE DAY PRIOR TO THE EVENT. THERE WAS NO PATIENT HARM.

Description of Event or Problem · 0

IT WAS REPORTED THAT THERE WAS AN UNDER INFUSION OF CEFTAROLINE (CEFTAROLINE 5.92 MG IN NSS 0.5 ML IVPB). THE ELECTRONIC MEDICAL RECORD (EMR) RECORDED ADMINISTRATION OF CEFTAROLINE, HOWEVER THE PATIENT DID NOT ACTUALLY RECEIVE THE MEDICATION. THE RATE, DATE/TIME SEEN IN THE EMR UNDER CEFTAROLINE IS THE RATE, DATE/TIME FOR THE INFUSION OF BLOOD (TRANSFUSE RBC) 14 ML. THE EVENT OCCURRED BETWEEN 0500-0800. THE RATES RECORDED IN THE EMR FOR CEFTAROLINE WAS ACTUALLY THE RATE OF THE BLOOD ACCORDING TO THE NURSE. 0528 ¿ 5 ML/HOUR, 0530 3.73 ML/HOUR, 0532 ¿ 4.91 ML/HOUR, 0600 ¿ 4.91 ML/HOUR, 0800 ¿ 4.91 ML/HOUR, 0821 ¿ NEW BAG, 0823 ¿ 1.5 ML/HOUR. THE BLOOD INFUSION WAS PROGRAMMED MANUALLY, THEY DID SCAN CEFTRAOLINE BUT IT IS NOT BUILT IN THE NEONATAL DRUG LIBRARY. CEFTRAOLINE DID ASSOCIATE TO THE PUMP FROM NIGHT¿S DOSE THE DAY PRIOR TO THE EVENT. THERE WAS NO PATIENT HARM.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1386229 ALARIS SYSTEM PUMP, INFUSION FRN CAREFUSION SD 8100 10885403810046

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown