FDA Adverse Event Summary report: N

FLEXI FLO III

MDR report key: 8994 · Received March 28, 1994

Report

Report Number
8994
Date Received
March 28, 1994
Date of Event
April 16, 1993
Report Date
June 11, 1993
Manufacturer
ROSS LABORATORIES
Product Code
FPD
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

A BAG OF GLUCERNA (1,000 CC) WAS HUNG AT 1:00 A.M. ON APRIL 16, 1993. THE PUMP WAS SET AT 80 CC'S PER HOUR. THE TUBE WAS FLUSHED APPROXIMATELY 4:15 A.M. AND NO PROBLEMS WERE IDENTIFIED. AT 5:00 A.M. THE PUMP BEGAN BEEPING AND THE BAG WAS FOUND EMPTY. THE VOLUME FED REGISTERED 356 CC ON THE PUMP BUT ACTUALLY MORE THAN 1,000 CC HAD INFUSED SINCE THE 3 - 11 SHIFT HAD CLEARED THE PUMP. THE PUMP WAS IMMEDIATELY TURNED OFF.DEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: INVALID DATA. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: . SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY.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, MECHANICAL TESTS PERFORMED, PERFORMANCE TESTS PERFORMED, VISUAL EXAMINATION. RESULTS OF EVALUATION: COMPONENT FAILURE, FLOWMETER. CONCLUSION: INVALID DATA, DEVICE FAILURE RELATED TO PATIENT CONDITION. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: DEVICE PERMANENTLY REMOVED FROM SERVICE. THE DEVICE WAS NOT DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 FLEXI FLO III FEEDING PUMP (EXTERNAL PUMP) FPD ROSS LABORATORIES N/A

Patients

Seq Age Sex Outcome Treatment
1 UNK Invalid Data