MAUDE Adverse Event Report: EPIC INTERNATIONAL (THAILAND) CO., LTD. / REGISTRAR CORP. SMARTEZ ELASTOMERIC INFUSION PUMP; SMARTEZ PUMP

Model Number SE0200-100

Device Problem Failure to Infuse (2340)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 12/11/2018

Event Type  malfunction  

Event Description

Smart ez pump (se0200-100, lot# unknown) containing zosyn 4.5 grams in 0.9% sodium chloride 100 ml would not infuse.Patient tried to disconnect / reconnect 6 times, confirmed it was dripping each time.Patient then connected to the other extension tubing and it infused without problem.

• Brand Name: SMARTEZ ELASTOMERIC INFUSION PUMP
• Type of Device: SMARTEZ PUMP
• Manufacturer (Section D): EPIC INTERNATIONAL (THAILAND) CO., LTD. / REGISTRAR CORP.
• MDR Report Key: 8164532
• MDR Text Key: 130617351
• Report Number: MW5082119
• Device Sequence Number: 1
• Product Code: MEB
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Voluntary
• Reporter Occupation: Pharmacist
• Type of Report: Initial
• Report Date: 12/12/2018

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: Lay User/Patient
• Device Model Number: SE0200-100
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 12/13/2018
• Was Device Evaluated by Manufacturer?: No Information
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: N
• Patient Sequence Number: 1