BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    B BRAUN

    MDR report key: 3474121 · Received November 13, 2013

    Report

    Report Number
    MW5032908
    Event Type
    Malfunction
    Date Received
    November 13, 2013
    Date of Event
    October 23, 2013
    Report Date
    November 12, 2013
    Manufacturer
    B BRAUN
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PT'S FATHER CAME OUT OF ROOM 72 YELLING FIRE. HOUSEKEEPER ENTERED ROOM AND SAW FLAMES. HOUSEKEEPER PULLED FIRE ALARM AND ASSISTED IN RELOCATING PT. SOURCE WAS B BRAUN IV PUMP EXTENSION CORD. THIS IS THE (B)(4) CORD THAT HAS CAUGHT FIRE AT KNF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    588545 B BRAUN IV PUMP FRN B BRAUN 33102708

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR