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

Model Number SE0175-250

Device Problem Improper Flow or Infusion (2954)

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

Event Date 12/03/2018

Event Type  malfunction  

Event Description

Smart ez pump (se0175-250, lot# unknown) containing telavancin 750 mg in 0.9% sodium chloride 250 ml took 8 hours to infuse.Patient line flushing fine.Ed drips quickly when disconnected and unclamped.Patient reconnected tightly without improvement.

• Brand Name: SMARTEZ ELASTOMERIC INFUSION PUMP
• Type of Device: SMARTEZ PUMP
• Manufacturer (Section D): EPIC INTERNATIONAL (THAILAND) CO., LTD. ; tasit; pluakdawng, rayong 21140 TH; TH 21140 TH
• MDR Report Key: 8141860
• MDR Text Key: 129881529
• Report Number: MW5081905
• 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: 12/05/2018

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: SE0175-250
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 12/06/2018
• 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