BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    EXCELSIOR

    MDR report key: 507334 · Received January 13, 2004

    Report

    Report Number
    MW1030830
    Event Type
    Malfunction
    Date Received
    January 13, 2004
    Date of Event
    January 11, 2004
    Report Date
    January 13, 2004
    Manufacturer
    EXCELSIOR MEDICAL CORP
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    EXCELSIOR PUMP SHAKING NOT-WORKING PROPERLY, TURNS ITSELF OFF DURING INFUSION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EXCELSIOR SYRINGE INFUSION PUMP FRN EXCELSIOR MEDICAL CORP ESP *

    Patients

    Seq Age Sex Outcome Treatment
    1 19 MO