MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a user facility report with the FDA on 2018-08-21 for MEDFUSION? MEDFUSION? 4000 WIRELESS SYRINGE INFUSION PUMP 4000-0101-51 manufactured by Smiths Medical Asd, Inc..
[117749017]
It was reported that the power supply of a syringe infusion pump was "burnt up a bit/smoke". No patient involvement was reported.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3012307300-2018-03351 |
| MDR Report Key | 7801475 |
| Report Source | USER FACILITY |
| Date Received | 2018-08-21 |
| Date of Report | 2018-08-21 |
| Date Mfgr Received | 2018-07-23 |
| Device Manufacturer Date | 2012-03-16 |
| Date Added to Maude | 2018-08-21 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | DAVE HALVERSON |
| Manufacturer Street | 6000 NATHAN LANE NORTH |
| Manufacturer City | MINNEAPOLIS MN 55442 |
| Manufacturer Country | US |
| Manufacturer Postal | 55442 |
| Manufacturer Phone | 7633833310 |
| Manufacturer G1 | SMITHS MEDICAL ASD, INC. |
| Manufacturer Street | 6000 NATHAN LANE NORTH |
| Manufacturer City | MINNEAPOLIS MN 55442 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 55442 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MEDFUSION? MEDFUSION? 4000 WIRELESS SYRINGE INFUSION PUMP |
| Generic Name | ACCESSORIES, PUMP, INFUSION |
| Product Code | MRZ |
| Date Received | 2018-08-21 |
| Returned To Mfg | 2018-07-31 |
| Model Number | 4000 |
| Catalog Number | 4000-0101-51 |
| Device Availability | R |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SMITHS MEDICAL ASD, INC. |
| Manufacturer Address | 6000 NATHAN LANE NORTH MINNEAPOLIS MN 55442 US 55442 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-08-21 |