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Catalog Number 2C1063KP |
Device Problem
Filling Problem (1233)
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Patient Problem
Injury (2348)
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Event Date 01/26/2017 |
Event Type
Injury
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Manufacturer Narrative
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(b)(6).The device was manufactured between: 16sep2016 and 19sep2016.A batch review was conducted and there were no deviations found related to this reported condition during the manufacture of this lot.The device was not received for evaluation; therefore, a device analysis could not be completed.Should additional relevant information become available, a supplemental report will be submitted.
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Event Description
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A patient experienced an overinfusion while connected to a large volume infusor.The device was filled with 1500mg of vancomycin diluted with 240ml of 0.9% sodium chloride.The solution was completely infused after 21 hours.Six days later, the patient was re-admitted to the hospital for estimated glomerular filtration rate, high creatinine and high vancomycin levels (exact levels were not reported).The cause of the over-infusion, treatment for the event, and the patient¿s outcome were not reported.No additional information is available.
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Manufacturer Narrative
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The patient¿s doctor reported there was no patient harm due to the infusor pump over-infusion incident; further stating that ¿the patient had none of the known vancomycin side effects¿.Subsequently, the patient was changed to daptomycin due to continuing fevers which the patient completed this week.Upon further review of the clinical circumstances the baxter disposable device is no longer considered suspect product in this event.Should additional relevant information become available, a supplemental report will be submitted.
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Search Alerts/Recalls
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