BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ON Q PUMP

    MDR report key: 2430100 · Received January 23, 2012

    Report

    Report Number
    MW5023986
    Event Type
    Malfunction
    Date Received
    January 23, 2012
    Date of Event
    January 18, 2012
    Report Date
    January 23, 2012
    Manufacturer
    KIMBERLY CLARK
    Product Code
    MEB
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    PHARMACIST

    Narratives

    Description of Event or Problem · 1

    PACU NURSE BROUGHT ON Q PUMP TO (B)(6) PHARMACY TO SHOW PHARMACIST THAT THE DIAL WAS MISSING ON THE ON Q PUMP. NEEDS ANOTHER DIAL. PHARMACY TECH LOCATED ANOTHER DIAL TO GIVE THE NURSE THE NEW DIAL. WHEN THE PHARMACY TECH BROUGHT IT TO HER, RN SAID SHE FOUND THE DIAL ON THE FLOOR. NO NEED FOR A NEW ONE. IT WAS NOT DETERMINED HOW THE DIAL FELL OFF OF THE PUMP. DIAL POPPED OFF OF AN ON Q PUMP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ON Q PUMP ON Q PUMP MEB KIMBERLY CLARK

    Patients

    Seq Age Sex Outcome Treatment
    1