BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD ALARIS PUMP INFUSION SET IV TUBING

    MDR report key: 8727280 · Received June 21, 2019

    Report

    Report Number
    MW5087553
    Event Type
    Malfunction
    Date Received
    June 21, 2019
    Date of Event
    June 19, 2019
    Report Date
    June 19, 2019
    Manufacturer
    BECTON DICKINSON AND COMPANY
    Product Code
    FPA
    UDI-DI
    07613203020992
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    RN OPENED BD ALARIS PUMP INFUSION SET AND NOTICED THERE WAS NO ROLLER CLAMP. FDA PRODUCT SAFETY REPORT ID# (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    518898 BD ALARIS PUMP INFUSION SET IV TUBING SET, ADMINISTRATION, INTRAVASCULAR FPA BECTON DICKINSON AND COMPANY 2426-0500 (10)19043177 07613203020992

    Patients

    Seq Age Sex Outcome Treatment
    1