BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PCA EMPTY STERILE

    MDR report key: 3172404 · Received June 5, 2013

    Report

    Report Number
    1021343-2013-00060
    Event Type
    Malfunction
    Date Received
    June 5, 2013
    Date of Event
    May 9, 2013
    Report Date
    May 9, 2013
    Manufacturer
    HOSPIRA INC.
    Product Code
    MEA
    PMA / PMN Number
    K042800
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    PHARMACIST

    Narratives

    Additional Manufacturer Narrative · 1

    THE CUSTOMER CONTACT INDICATED THE DEVICE WAS DISCARDED. INVESTIGATION IS NOT COMPLETE. THIS REPORT REPRESENTS ALL THE INFORMATION KNOWN BY THE REPORTER UPON QUERY BY HOSPIRA PERSONNEL.

    Description of Event or Problem · 1

    THE CUSTOMER CONTACT REPORTED A LEAK. IT WAS REPORTED THAT AN UNSPECIFIED VOLUME OF SOLUTION LEAKED DURING MANUAL FILLING OF THE VIAL AT THE USER FACILITY. THE CUSTOMER CONTACT REPORTED THE VIAL WAS BEING FILLED WITH AN UNSPECIFIED VOLUME OF MORPHINE 1 MG/ML WHEN SOLUTION LEAKED PROXIMAL TO THE FLANGE OF THE INJECTOR IN THE VIAL. THE VIAL WAS REPLACED AND THE FILLING WAS RESUMED. THOUGH REQUESTED, NO ADDITIONAL INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    249563 PCA EMPTY STERILE 80MEA MEA HOSPIRA INC. NA 16248R1

    Patients

    Seq Age Sex Outcome Treatment
    1 NA