BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INFUSOMAT SPACE PUMP

    MDR report key: 2932143 · Received January 19, 2013

    Report

    Report Number
    MW5028711
    Event Type
    Malfunction
    Date Received
    January 19, 2013
    Date of Event
    December 15, 2012
    Report Date
    January 19, 2013
    Manufacturer
    BRAUN
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    POSSIBLE PUMP ERROR/MALFUNCTION. HEPARIN DRIP STARTED AT 0000 (B)(6). VERIFIED BY 2 RN'S. RN NOTED ONLY 25 TO 50 CC REMAINING IN BAG AT 0600. MD NOTIFIED. HEPARIN DRIP DC.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    28595 INFUSOMAT SPACE PUMP INFUSOMAT SPACE PUMP FRN BRAUN

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR