BEUDAMED
    FDA Adverse Event Other Summary report: N

    HOSPIRA PLUM A+

    MDR report key: 924364 · Received September 27, 2007

    Report

    Report Number
    MW5003960
    Event Type
    Other
    Date Received
    September 27, 2007
    Date of Event
    September 19, 2007
    Report Date
    September 27, 2007
    Manufacturer
    HOSPIRA
    Product Code
    FRN
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IN, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    WHILE RECEIVING IV IRON SUCROSE VIA HOSPIRA PLUM A+ PUMP - FIRST TIME BEING USED ON THIS PT. PUMP POSITIONED NEAR SHOULDER - PATIENT, CLAIMS SHE WAS "ZAPPED" AT HER PACEMAKER SITE. SHE PUSHED PUMP APPROX 2 FT. AWAY AND HAD NO FURTHER EVENTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOSPIRA PLUM A+ INFUSION PUMP FRN HOSPIRA

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Other GUIDANT INSIGNA 1 ULTRA DUAL CHAMBER PACEMAKER| RIGHT VENRICULAR LEAD FINELINE II #4473| RIGHT ATRIAL LEAD 4472| IMPLANTED