BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD PYXIS¿ MEDFLEX 1000

    MDR report key: 24725792 · Received March 30, 2026

    Report

    Report Number
    2016493-2026-17251
    Event Type
    Malfunction
    Date Received
    March 30, 2026
    Date of Event
    December 31, 2025
    Report Date
    March 25, 2026
    Manufacturer
    CAREFUSION 303, INC.
    Product Code
    BRY
    UDI-DI
    10885403512704
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, 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, 13-MAR-2025 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 THE INCIDENT, IT WAS DETERMINED BY THE TECHNICAL SUPPORT SPECIALIST (TSS) WITNESSED THAT THE CUSTOMER ATTEMPTED TO ISSUE ROCEPHIN 1GM BUT QOH (QUANTITY ON HAND)SHOWED 0; ASSISTED IN VERIFYING THROUGH CYCLE COUNT THAT THE ITEM WITH QOH=4 WAS ACTUALLY FORTAZ/TAZICEF IN BIN 01 14 02, NOT ROCEPHIN IN BIN 01 13 01. DURING RESTOCK, CUSTOMER SCANNED THE ITEM ID INSTEAD OF THE LABEL BARCODE AND THEN INCORRECTLY COMPLETED A RESTOCK FOR BIN 01 14 02 USING ROCEPHIN. GUIDED THE CUSTOMER TO CORRECT THE COUNT BY CYCLE COUNTING THE BIN AND SETTING QOH=3. ADVISED NOTIFYING PHARMACY ABOUT THE INCORRECT MED OR BARCODE AND TO CHECK FOR YELLOW BANNER ERRORS AND CONTACT TSS IF THE APPLICATION DOES NOT PROCEED. CUSTOMER APPROVED CLOSING THE CASE.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT WHEN USING THE BD PYXIS¿ MEDFLEX 1000, THE CUSTOMER WAS UNABLE TO ISSUE, RESTOCK (4 UNITS), OR PERFORM A CYCLE COUNT FOR CEFTRIAXONE INJECTION 1 G. NO ACTION OCCURRED WHEN THE NEXT BUTTON WAS SELECTED. THE CUSTOMER STATED THAT THIS MALFUNCTION OCCURRED WHILE DISPENSING THE MEDICATION. HOWEVER, THERE WERE NO DELAYS OR ADVERSE EVENTS OR INJURIES REPORTED BASED ON THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    792086 BD PYXIS¿ MEDFLEX 1000 AUTOMATED DISPENSING CABINET BRY CAREFUSION 303, INC. 500004502000 10885403512704

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown