MAUDE Adverse Event Report: HALYARD ECLIPSE HOMEPUMP

Model Number E102000

Device Problems Crack (1135); Leak/Splash (1354)

Patient Problem No Information (3190)

Event Date 10/12/2017

Event Type  malfunction  

Event Description

Upon arrival to the infusion center, the tubing one eclipse homepump, model # e102000, lot # 0202702677, filled with daptomycin 800 mg/0.9 percent sodium chloride 100 ml was cracked and leaked.

• Brand Name: ECLIPSE HOMEPUMP
• Type of Device: ECLIPSE HOMEPUMP
• Manufacturer (Section D): HALYARD; alpharetta GA 30004
• MDR Report Key: 6968430
• MDR Text Key: 90064085
• Report Number: MW5072880
• 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: 10/19/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/23/2017
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: E102000
• Device Lot Number: 0202702677
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• 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