BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    EXCELSIOR SYRINGE PUMP

    MDR report key: 707599 · Received April 10, 2006

    Report

    Report Number
    MW1038445
    Event Type
    Malfunction
    Date Received
    April 10, 2006
    Date of Event
    April 7, 2006
    Report Date
    April 10, 2006
    Manufacturer
    EXCELSIOR MEDICAL CORP
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    ESP PUMP WOULD NOT RUN WHEN TURNED ON. WOULD LIGHT UP FOR APPROX 10 SECONDS AND WOULD THEN ALARM AND ALL LIGHTS WOULD FLASH.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 3.5 YR Other