MAUDE Adverse Event Report: B. BRAUN MELSUNGEN AG EASYPUMP II; ELASTOMERIC INFUSION PUMP

Catalog Number 4540038

Device Problem No Flow (2991)

Patient Problem No Information (3190)

Event Type  malfunction  

Event Description

As reported by the user facility (translation of user facility information by bbm sales organization of the (b)(4)): infusion blocked.The pump with physiological and fluorouraci, after 2/3 days blocked the infusion.The content crystallizes.Probably it's due to the new prod used by accord.

Manufacturer Narrative

(b)(4).The device is currently shipping from the customer to bbm in (b)(4) for investigation.A f/u report will be provided when the inspection results become available.Imp-(b)(4).

• Brand Name: EASYPUMP II
• Type of Device: ELASTOMERIC INFUSION PUMP
• Manufacturer (Section D): B. BRAUN MELSUNGEN AG; carl-braun-str.1; melsungen 3421 2; GM 34212
• Manufacturer Contact: ludwig schuetz ; carl-braun-str.1; melsungen D-342-12 ; GM D-34212 ; 661712769
• MDR Report Key: 4586536
• MDR Text Key: 5447017
• Report Number: 9610825-2015-00065
• Device Sequence Number: 1
• Product Code: BSO
• Combination Product (y/n): N
• Reporter Country Code: IT
• PMA/PMN Number: K081905
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility,Company Representative
• Reporter Occupation: Other Health Care Professional
• Remedial Action: Other
• Type of Report: Initial
• Report Date: 03/06/2015,02/09/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/06/2015
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 05/01/2017
• Device Catalogue Number: 4540038
• Device Lot Number: 2E1528ET11
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: Yes
• Date Report Sent to FDA: 03/06/2015
• Distributor Facility Aware Date: 03/02/2015
• Device Age: 9 MO
• Event Location: Hospital
• Date Report to Manufacturer: 03/06/2015
• Date Manufacturer Received: 02/09/2015
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 05/01/2012
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1