BEUDAMED
    FDA Adverse Event Injury Summary report: N

    *

    MDR report key: 453978 · Received April 10, 2003

    Report

    Report Number
    MW1028129
    Event Type
    Injury
    Date Received
    April 10, 2003
    Date of Event
    May 22, 2002
    Report Date
    February 10, 2003
    Manufacturer
    HORIZON PUMP IV SET
    Product Code
    FPA
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    PHARMACIST

    Narratives

    Description of Event or Problem · 1

    LARGE VOLUME HYDRATING IV TUBING WAS INSERTED INTO THE HORIZON PUMP AND A VERY RAPID FLOW RATE OCCURRED (FREE FLOW). THE PUMP WAS CHANGED AND INSERTED THE SAME TUBING INTO ANOTHER PUMP WITH THE SAME RAPID FLOW RATE RESULT. THERE WAS NO CHANGE IN THE PT'S STATUS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * IV SET FPA HORIZON PUMP IV SET V74108070031 *

    Patients

    Seq Age Sex Outcome Treatment
    1 23 YR Hospitalization