BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COLLEAGUE 3-CHANNEL

    MDR report key: 753825 · Received August 10, 2006

    Report

    Report Number
    MW1040020
    Event Type
    Malfunction
    Date Received
    August 10, 2006
    Date of Event
    July 26, 2006
    Report Date
    August 10, 2006
    Manufacturer
    BAXTER HEALTHCARE
    Product Code
    FRN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    KY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PUMP FAILED WHILE ON A PT. CAHNNEL A FAILED AND STATED A PUMP FAILURE. EVENT HISTORY SHOWS 3 FAILURE CODES: 715.00 AND 4:311:3686:001D AND 803:07.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COLLEAGUE 3-CHANNEL INFUSION PUMP FRN BAXTER HEALTHCARE 2M8153 *
    2 * * --- * * *

    Patients

    Seq Age Sex Outcome Treatment
    1 *