BEUDAMED
    FDA Adverse Event Death Summary report: N

    3M

    MDR report key: 234721 · Received August 2, 1999

    Report

    Report Number
    234721
    Event Type
    Death
    Date Received
    August 2, 1999
    Date of Event
    July 7, 1999
    Report Date
    July 30, 1999
    Manufacturer
    3M AVI, INC.
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT WAS TO RECEIVE 40MCQ KCL PREMIXED IN 100ML STERILE WATER TO INFUSE OVER TWO HRS. THE INFUSION PUMP RATE WAS SET AT 50ML/HR. APPROXIMATELY 7-10 MINS AFTER THE INFUSION WAS STARTED, THE PUMP WAS ALARMING BECAUSE THE BAG WAS EMPTY. THE RATE AT THIS TIME WAS NOTED TO BE 500ML/HR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 3M AVI 470 INFUSION PUMP FRN 3M AVI, INC. 470 *

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Death