FDA Adverse Event Injury Summary report: N

SYNCHROMED II

MDR report key: 3173690 · Received June 17, 2013

Report

Report Number
3007566237-2013-02001
Event Type
Injury
Date Received
June 17, 2013
Report Date
May 21, 2013
Manufacturer
MDT PUERTO RICO OPERATIONS CO
Product Code
LKK
PMA / PMN Number
P860004
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
UT, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

(B)(4).

Description of Event or Problem · 1

IT WAS LATER REPORTED THAT THERE WAS A CATHETER MALFUNCTION. THE PATIENT EXPERIENCED INCREASED PAIN. A DYE STUDY AND REVISION WAS DONE. THE DEVICE SYSTEM WAS USED TO DELIVER DILAUDID 400MG/ML AT 6.822/DAY.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE HCP WAS UNABLE TO WITHDRAW MORE THAN 0.1ML OF FLUID DURING A CATHETER DYE STUDY SO WAS NOT COMFORTABLE PUSHING CONTRAST THROUGH. THE CATHETER WAS NOT RE-PRIMED. THE CATHETER WAS FOLLOWED FROM THE PUMP UP TO THE TIP AND NOTHING SUSPICIOUS WAS SEEN. THE PATIENT WAS BEING REFERRED FOR A CATHETER REPLACEMENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PATIENT HAD A CATHETER REPLACEMENT AND OTHER COMPLICATIONS IN THE PAST. THE FOLLOWING INFORMATION IS A SEPARATE EVENT AND WAS PREVIOUSLY REPORTED IN MANUFACTURER¿S REPORT #3004209178-2013-10256: [IT WAS REPORTED THAT THE HCP WAS UNABLE TO WITHDRAW MORE THAN 0.1ML OF FLUID DURING A CATHETER DYE STUDY SO WAS NOT COMFORTABLE PUSHING CONTRAST THROUGH. THE CATHETER WAS NOT RE-PRIMED. THE CATHETER WAS FOLLOWED FROM THE PUMP UP TO THE TIP AND NOTHING SUSPICIOUS WAS SEEN. THE PATIENT WAS BEING REFERRED FOR A CATHETER REPLACEMENT.]

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
273753 SYNCHROMED II PUMP, INFUSION, IMPLANTED, PROGRAMMABLE LKK MDT PUERTO RICO OPERATIONS CO 8637-40

Patients

Seq Age Sex Outcome Treatment
1 00055 YR Required Intervention