BEUDAMED
    FDA Adverse Event Other Summary report: N

    INFUSION PUMP

    MDR report key: 25420 · Received September 11, 1995

    Report

    Report Number
    MW1006896
    Event Type
    Other
    Date Received
    September 11, 1995
    Date of Event
    August 24, 1995
    Report Date
    August 28, 1995
    Manufacturer
    3M/AVI
    Product Code
    FRN
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    BIOMEDICAL ENGINEER

    Narratives

    Description of Event or Problem · 1

    PT RECEIVED OVERINFUSION DUE TO GRAVITY FEED ON INFUSION PUMP. SPRING OCCLUSION CLAMP WAS STUCK OPEN PREVENTING PROPER OPERATION OF MECHANISM. CLAMP STUCK OPEN DUE TO CONTAMINATION FROM IV SOLUTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INFUSION PUMP PUMP FRN 3M/AVI 200

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other