FDA Adverse Event Malfunction Summary report: N

AVI 110

MDR report key: 8196 · Received August 11, 1993

Report

Report Number
8196
Event Type
Malfunction
Date Received
August 11, 1993
Date of Event
April 29, 1993
Report Date
June 21, 1993
Manufacturer
AVI, INC. 3M HEALTHCARE
Product Code
FRN
Product Problem
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

AT 1830 IV TUBING NOTED TO BE CLAMPED OFF, PUMP HAD NOT ALARMED "OCCLUDED" ETC. SINCE 1530. INFANT RECEIVING "SPECIAL FLUIDS" (HYPER-AL). MD NOTIFIED. SINCE PTS GLUCOSE WAS KNOWN TO BE TOO LOW, DIOW BOLUS IV GIVEN, GLUCOSE CHECKED 30 MIN. INTERVALS UNTIL STABLE. OLD PUMP REPLACED.DEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: FAIR CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: 01-MAY-92. SERVICE PROVIDED BY: USER FACILITY BIOMEDICAL/BIOENGINEERING DEPARTMENT. SERVICE RECORDS AVAILABLE.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, PERFORMANCE TESTS PERFORMED. RESULTS OF EVALUATION: ALARM FAILURE. CONCLUSION: DEVICE FAILURE OCCURRED AND WAS RELATED TO EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: DEVICE REPAIRED AND PUT BACK IN SERVICE. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 AVI 110 INFUSION PUMP FRN AVI, INC. 3M HEALTHCARE 110

Patients

Seq Age Sex Outcome Treatment
1 UNK Other