MAUDE Adverse Event Report: HOSPIRA COSTA RICA LTD. LC PCA HOSPIRA MEDNE; 80MEA

Catalog Number 20709

Device Problem Device Inoperable (1663)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 03/20/2014

Event Type  malfunction  

Event Description

The customer contact reported an e630 (screw rotation error) error code was noted.The device was returned to the biomedical department with an unsigned note that stated, "malfunction".No tracking info was provided; therefore, specific patient info, pump programming, or event details were not available.There were no reports of any adverse patient events or delays in critical therapies while the device was in clinical use.During testing at the user facility, an e630 (screw rotation error) error code was noted.No add'l info was provided.

Manufacturer Narrative

The device was rec'd.Investigation is not complete.This report represents all the info known by the reporter upon query by hospira personnel.

• Brand Name: LC PCA HOSPIRA MEDNE
• Type of Device: 80MEA
• Manufacturer (Section D): HOSPIRA COSTA RICA LTD.; zona franca global; la aurora de heredia ; CS
• Manufacturer (Section G): HOSPIRA COSTA RICA LTD.; zona franca global; la aurora de heredia ; CS
• Manufacturer Contact: juergen schmider, md, vp ; 275 n. field drive; bldg no h2-1east dept no 097u; lake forest, IL 60045 ; 2242125740
• MDR Report Key: 3964069
• MDR Text Key: 4607024
• Report Number: 9615050-2014-03206
• Device Sequence Number: 1
• Product Code: MEA
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K042800
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 04/09/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: 20709
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 04/29/2014
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 04/09/2014
• Initial Date FDA Received: 05/05/2014
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 03/01/2011
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Removal/Correction Number: FA301-02
• Patient Sequence Number: 1