FDA Adverse Event Malfunction Summary report: N

SPECTRUM INFUSION PUMP

MDR report key: 4843872 · Received June 3, 2015

Report

Report Number
1314492-2015-06507
Event Type
Malfunction
Date Received
June 3, 2015
Date of Event
April 1, 2015
Report Date
May 11, 2015
Manufacturer
BAXTER HEALTHCARE CORP.
Product Code
FRN
PMA / PMN Number
K042121
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CO, US
Reporter Occupation
BIOMEDICAL ENGINEER

Narratives

Additional Manufacturer Narrative · 1

(B)(4). BAXTER EVALUATED THE DEVICE AND FOUND THAT THE UPSTREAM SENSOR WAS FAILING. IT WAS DETERMINED THAT THIS FAILING PART CAUSED THE FALSE UPSTREAM OCCLUSION ALARMS AND HAS BEEN REPLACED.

Description of Event or Problem · 1

DURING THE REVIEW OF THE EVENT HISTORY LOG IT WAS DETERMINED THAT A REPEATING PATTERN OF UPSTREAM OCCLUSION ALARMS SUGGESTS THAT THE DEVICE WAS FALSELY ALARMING FOR UPSTREAM OCCLUSIONS. THE OCCURRENCES SUGGEST A DEVICE MALFUNCTION. ANY PATIENT INVOLVEMENT, INJURY OR MEDICAL INTERVENTION IS UNKNOWN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
359334 SPECTRUM INFUSION PUMP INFUSION PUMP FRN BAXTER HEALTHCARE CORP. 35700

Patients

Seq Age Sex Outcome Treatment
1