BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ALARIS

    MDR report key: 3695428 · Received March 14, 2014

    Report

    Report Number
    MW5035096
    Event Type
    Injury
    Date Received
    March 14, 2014
    Date of Event
    March 7, 2014
    Report Date
    March 14, 2014
    Manufacturer
    CARE FUSION
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    MODULE FOR PUMP DISCONNECTED AND ERROR. PUMP REPLACED. NO PT INJURY. DIAGNOSIS OR REASON FOR USE: PANCREATIC PSEUDOCYST/NPO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    152165 ALARIS INFUSION PUMP FRN CARE FUSION 8100

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR Required Intervention