BEUDAMED
    FDA Adverse Event Injury Summary report: N

    *

    MDR report key: 404108 · Received July 3, 2002

    Report

    Report Number
    404108
    Event Type
    Injury
    Date Received
    July 3, 2002
    Date of Event
    June 16, 2002
    Report Date
    June 28, 2002
    Manufacturer
    BAXTER
    Product Code
    FRN
    Report Source
    User Facility report
    Reporter Location
    WI, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    KOL MINI-BAG INSERTED INTO INCORRECT TUBING PORT, BYPASSING PUMP RESULTING IN FREE FLOW.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * DUAL CHANNEL INFUSION PUMP FRN BAXTER 6301 *

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR Required Intervention