BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CAREFUSION

    MDR report key: 3890191 · Received May 21, 2014

    Report

    Report Number
    3890191
    Event Type
    Injury
    Date Received
    May 21, 2014
    Date of Event
    March 17, 2014
    Report Date
    May 14, 2014
    Manufacturer
    CAREFUSION
    Product Code
    FRN
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PT RETURNED TO CVCCU APPROXIMATELY 1500, INSULIN DRIP INITIATED FOR BLOOD GLUCOSE OF 126 AT 2ML/HR(2 UNITS/HR) ON IV PUMP. APPROXIMATELY 10 MINUTES LATER, NOTICED INSULIN DRIP BAG WAS EMPTY/DRY. STOPPED IV PUMP, CLAMPED DRIP TUBING, AND CHECKED PT'S BLOOD SUGAR. PUMP VOLUME INFUSED DISPLAYED CORRECTLY AT 0.4ML. PT REQUIRED BLOOD GLUCOSE MONITORING EVERY 15 MINUTES AND LATER CHANGED TO EVERY 30 MINUTES. NO ADVERSE CONDITIONS WERE REACHED. IV PUMP IN QUESTION WAS IMMEDIATELY REMOVED FROM SERVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    303605 CAREFUSION ALARIS IV PUMP MODULE FRN CAREFUSION 8100, 8015

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Required Intervention