BEUDAMED
    FDA Adverse Event Injury Summary report: N

    INFUSOMAT SPACE IV PUMP

    MDR report key: 3901842 · Received June 23, 2014

    Report

    Report Number
    MW5036879
    Event Type
    Injury
    Date Received
    June 23, 2014
    Date of Event
    June 20, 2014
    Report Date
    June 20, 2014
    Manufacturer
    B. BRAUN
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    CORD ADAPTOR BEGAN SMOKING. PATIENT REMOVED FROM ROOM. FIRE EXTINGUISHER DISCHARGED ALTHOUGH NO FIRE. FIRE DEPARTMENT CAME. NO FIRE BEHIND WALL PER FIRE DEPARTMENT. ADAPTER CHARRED. IV PUMP WAS NOT IN USE AT TIME OF EVENT. IV PUMP WAS PLUGGED INTO WALL AND TURNED OFF. NO HARM TO PATIENT. PLANT OPERATIONS TESTED OUTLET AFTER EVENT. NO ISSUES. OUTLET ALSO CHECKED BY ELECTRICIAN ON (B)(6) 2014 - NO ISSUES FOUND WITH OUTLET. LAST BIOMED CHECK (B)(6) 2014. BBRAUN RECOMMENDS FACILITY BIOMED COMP HAVE IV PUMP TESTED SINCE APPEARS POWER SUPPLY / ADAPTER IS ISSUE. NO INJURY R/T WAS NOT IN USER AT TIME OF INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    367026 INFUSOMAT SPACE IV PUMP IV PUMP FRN B. BRAUN

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Required Intervention