BEUDAMED
    FDA Adverse Event Other Summary report: N

    BELMONT RAPID INFUSER TUBING

    MDR report key: 3905781 · Received June 26, 2014

    Report

    Report Number
    MW5036906
    Event Type
    Other
    Date Received
    June 26, 2014
    Date of Event
    June 3, 2014
    Report Date
    June 12, 2014
    Manufacturer
    BELMONT INSTRUMENT CORP
    Product Code
    FRN
    Report Source
    Voluntary report
    Reporter Location
    OR, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    ATTEMPTING TO TRANSFUSE BLOOD DURING MASSIVE TRANSFUSION. BELMONT RAPID INFUSER TUBING NOTED TO BE LEAKING DISTAL TO PRESSURE CHAMBER WHERE SMALLER TUBING IS JOINED TO PRESSURE CHAMBER. BLOOD WAS DRIPPING OUT OF HOLE IN TUBING. INFUSION STOPPED - NEW TUBING USED WITHOUT PROBLEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    373397 BELMONT RAPID INFUSER TUBING TUBING FRN BELMONT INSTRUMENT CORP 903-00006P 2013-11 05

    Patients

    Seq Age Sex Outcome Treatment
    1 86 YR