FDA Adverse Event Malfunction Summary report: N

SPECTRUM INFUSION PUMP

MDR report key: 4781082 · Received May 15, 2015

Report

Report Number
1314492-2015-06003
Event Type
Malfunction
Date Received
May 15, 2015
Date of Event
April 1, 2015
Report Date
April 22, 2015
Manufacturer
BAXTER HEALTHCARE CORP.
Product Code
FRN
PMA / PMN Number
K042121
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
SD, US
Reporter Occupation
BIOMEDICAL ENGINEER

Narratives

Additional Manufacturer Narrative · 1

(B)(4). BAXTER RECEIVED AND EVALUATED THE DEVICE. THE DEVICE WAS FOUND OUT OF SPECIFICATION IN RELATION TO THE SYSTEM ERROR 105, WHICH WAS OBSERVED DURING POWER UP. SYSTEM ERROR 105 WAS CONFIRMED AND CAUSED BY A FAILED MOTOR FLEX. THE FAILED MOTOR ASSEMBLY WAS REPLACED.

Description of Event or Problem · 1

IT WAS REPORTED THAT A SPECTRUM PUMP DISPLAYED SYSTEM ERROR 105. IT WAS ALSO REPORTED THERE WAS NO PT INVOLVEMENT. THE EVENT OCCURRED IN THE ONCOLOGY CARE AREA.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
318631 SPECTRUM INFUSION PUMP INFUSION PUMP FRN BAXTER HEALTHCARE CORP. 35700

Patients

Seq Age Sex Outcome Treatment
1