BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD PYXIS¿ MEDSTATION¿ ES

    MDR report key: 24143434 · Received January 22, 2026

    Report

    Report Number
    2016493-2026-01527
    Event Type
    Malfunction
    Date Received
    January 22, 2026
    Date of Event
    January 5, 2026
    Report Date
    January 19, 2026
    Manufacturer
    CAREFUSION 303, INC.
    Product Code
    BRY
    UDI-DI
    10885403533228
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    A REVIEW OF THE COMPLAINT HISTORY FOR SN (B)(6) WAS PERFORMED IN SALESFORCE WHICH DID NOT LOCATE SIMILAR COMPLAINT(S) WITH THE SAME FAILURE MODE FOR THIS SERIAL NUMBER. A REVIEW OF THE DEVICE HISTORY RECORD FOR SN (B)(6) WAS PERFORMED FROM THE DATE OF MANUFACTURE, 25-MAY-2023 AND CONFIRMED THAT THIS DEVICE WAS NOT PREVIOUSLY RETURNED FOR SERVICING AND THERE WERE NO PRODUCTION FAILURES WHICH CORRELATES TO THE CUSTOMER REPORTED ISSUE. UPON INVESTIGATION OF THE ACTUAL DEVICE USED IN THIS INCIDENT IT WAS DETERMINED THAT 2 DISCONTINUED MEDICATIONS THAT WERE STILL SHOWING UP ON THE STATION FOR 1 PATIENT. A TECHNICAL SUPPORT SPECIALIST (TSS) FOUND THAT SYNCHRONIZATION STATUS WAS CURRENT AND NORMAL MESSAGE PROCESSING, WITH NO PENDING DOWNLOADS. FURTHER VALIDATION OF PATIENT DATA SHOWED THAT THE PATIENT HAD BEEN DISCHARGED ON 5 JANUARY, YET THE MEDICATIONS ASSOCIATED WITH MEDICATION IDENTIFICATION (MED ID) 4083005 AND MED ID 4089301 REMAINED ACTIVE, AS NO DISCONTINUE/END DATES WERE SET FOR THESE ORDERS ON THE SERVER. THE CUSTOMER WAS ADVISED TO CONTACT THE ADMIT DISCHARGE TRANSFER (ADT) TEAM TO UPDATE THE MEDICATION ORDERS TO DISCONTINUED, AS THE MISSING DISCONTINUE MESSAGES WERE CAUSING THEM TO CONTINUE APPEARING IN PYXIS. THE OTHER REASON MIGHT BE EXTRACT TRANSPORT LOAD (ETL) OR DATA SYNCHRONIZATION DELAYS ON THE PYXIS SERVER. HOWEVER, DUE TO LACK OF RESPONSE FROM CUSTOMER TSS CLOSED THE CASE.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT WHEN USING THE BD PYXIS¿ MEDSTATION¿ ES USER OBSERVED THAT TWO DISCONTINUED MEDICATION ORDERS WERE STILL APPEARING FOR A PATIENT ON THE STATION. THIS PROMPTED THE NURSE TO ATTEMPT TO PULL THE MEDICATION. IDEALLY, THERE SHOULD BE ONE DISCONTINUED ORDER AND ONE ACTIVE ORDER FOR THIS MEDICATION. HOWEVER, BOTH ORDERS ARE INCORRECTLY DISPLAYED AS DISCONTINUED FOR THE PATIENT. THE CUSTOMER STATED THAT THIS MALFUNCTION OCCURRED WHILE DISPENSING THE MEDICATION. THERE WERE NO ADVERSE EVENTS OR INJURIES REPORTED BASED ON THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    206356 BD PYXIS¿ MEDSTATION¿ ES AUTOMATED DISPENSING CABINET BRY CAREFUSION 303, INC. 500001002500 10885403533228

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown