FDA Adverse Event Malfunction Summary report: N

CADD LEGACY PLUS PUMP

MDR report key: 12308322 · Received August 11, 2021

Report

Report Number
3012307300-2021-08309
Event Type
Malfunction
Date Received
August 11, 2021
Report Date
March 1, 2022
Manufacturer
ST PAUL
Product Code
FRN
UDI-DI
10610586019647
PMA / PMN Number
K982836
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
FL, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

OTHER, OTHER TEXT: CUSTOMER REPORTED THAT DEVICE WAS SHOWING NO DISPOSABLE ALARM. TAMPER SEALS WERE ALL INTACT, LOOSE UPPER BACK LABEL. CUSTOMER PROBLEM WAS NOT DUPLICATED. PERFORMED VISUAL INSPECTION OF THE PUMP, AND NDA TESTING. UNABLE TO DETERMINE WHAT CAUSED THE PROBLEM. REPLACED DOWNSTREAM SENSOR AS A PREVENTIVE MEASURE.

Additional Manufacturer Narrative · 0

OTHER, OTHER TEXT: CUSTOMER REPORTED THAT DEVICE WAS SHOWING NO DISPOSABLE ALARM. TAMPER SEALS WERE ALL INTACT, LOOSE UPPER BACK LABEL. CUSTOMER PROBLEM WAS NOT DUPLICATED. PERFORMED VISUAL INSPECTION OF THE PUMP, AND NDA TESTING. UNABLE TO DETERMINE WHAT CAUSED THE PROBLEM. REPLACED DOWNSTREAM SENSOR AS A PREVENTIVE MEASURE.

Description of Event or Problem · 0

IT WAS REPORTED THAT DEVICE WAS SHOWING NO DISPOSABLE ALARM. NO PATIENT INJURY WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT DEVICE WAS SHOWING NO DISPOSABLE ALARM. NO PATIENT INJURY WAS REPORTED.

Description of Event or Problem · 1

INFORMATION WAS RECEIVED INDICATING THAT DURING TESTING OF THIS SMITHS MEDICAL CADD LEGACY PLUS PUMP, THE PUMP EXHIBITED NO DISPOSABLE ALARM. NO PATIENT INVOLVEMENT REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1206816 CADD LEGACY PLUS PUMP PUMP, INFUSION FRN ST PAUL 6500 10610586019647

Patients

Seq Age Sex Outcome Treatment
1 Unknown