BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SAPPHIRE M.T INFUSION PUMP - FRENCH

    MDR report key: 6098277 · Received November 13, 2016

    Report

    Report Number
    3010293992-2016-00255
    Event Type
    Malfunction
    Date Received
    November 13, 2016
    Date of Event
    November 20, 2014
    Report Date
    November 13, 2016
    Manufacturer
    Q CORE MEDICAL LTD.
    Product Code
    FRN
    UDI-DI
    07290109150109
    PMA / PMN Number
    K123049
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 1

    DISTRIBUTOR INFORMATION: HOSPIRA INC. US SERVICE CENTER, (B)(4), EXEMPTION NUMBER, E2014005. Q CORE MEDICAL LTD (MANUFACTURER) IS SUBMITTING THE REPORT ON BEHALF OF HOSPIRA. THIS COMPLAINT WAS NOT DEEMED REPORTABLE UNDER THE THEN EFFECTIVE REPORTING PROCEDURE, BUT IS REPORTABLE UNDER REVISED REPORTING PROCEDURE WHICH EXERCISES STRICTER INTERPRETATION TO REPORTING OBLIGATION. THIS CASE IS AN OUTCOME OF RETROSPECTIVE REVIEW PERFORMED ON ALL OUR OLD NON-REPORTABLE EVENTS, TO ENSURE ALL OUR CASES ARE IN -PART WITH OUR NEW PROCEDURE (OF THE ~920 FILES REVIEWED IN THE RETROSPECTIVE REVIEW 33 CASES WERE DEEMED REPORTABLE BASED ON THE CURRENT REPORTING SCHEME. OF COURSE NONE HAD SERIOUS INJURY OR DEATH, AS THOSE ARE REPORTABLE UNDER OLD AND NEW PROCEDURES).

    Description of Event or Problem · 1

    "BOLUS OVER DELIVERY. THE PATIENT DESCRIBED A BOLUS WHICH HAS BEEN DELIVERED DURING MORE THAN 2 HOURS. THE NURSE IS SUSPICIOUS ABOUT THE FLOW ADMINISTRATED BECAUSE THE BAG WAS EMPTY WHEN SHE RETURNED TO THE PATIENT HOME. PATIENT INVOLVEMENT: YES. DEATH/SERIOUS INJURY: NO. HUMAN HARM: NO."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    749389 SAPPHIRE M.T INFUSION PUMP - FRENCH INFUSION PUMP FRN Q CORE MEDICAL LTD. 07290109150109

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown