FDA Adverse Event Malfunction Summary report: N

CADD

MDR report key: 13427768 · Received February 2, 2022

Report

Report Number
3012307300-2022-02386
Event Type
Malfunction
Date Received
February 2, 2022
Date of Event
January 15, 2022
Report Date
February 2, 2022
Manufacturer
ST PAUL
Product Code
FRN
UDI-DI
10610586019647
PMA / PMN Number
K982836
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
KS, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

NO PRODUCT OR PHOTOGRAPHIC EVIDENCE WERE PROVIDED TO AID IN THIS INVESTIGATION. THE COMPLAINT REPORT OFFERED INSUFFICIENT DETAILS TO DETERMINE WHETHER THIS PRODUCT FUNCTIONED AS INTENDED OR WAS USED IN A MANNER CONSISTENT WITH ITS INSTRUCTIONS FOR USE (IFU) OR FAILED TO MEET PRODUCT SPECIFICATIONS. LACKING ANY ADDITIONAL EVIDENCE, THIS COMPLAINT HAS BEEN CLOSED AS UNCONFIRMED. IF THE PRODUCT IS RETURNED, SMITHS MEDICAL WILL REOPEN THIS COMPLAINT FOR FURTHER INVESTIGATION.

Additional Manufacturer Narrative · 0

NO PRODUCT OR PHOTOGRAPHIC EVIDENCE WERE PROVIDED TO AID IN THIS INVESTIGATION. THE COMPLAINT REPORT OFFERED INSUFFICIENT DETAILS TO DETERMINE WHETHER THIS PRODUCT FUNCTIONED AS INTENDED OR WAS USED IN A MANNER CONSISTENT WITH ITS INSTRUCTIONS FOR USE (IFU) OR FAILED TO MEET PRODUCT SPECIFICATIONS. LACKING ANY ADDITIONAL EVIDENCE, THIS COMPLAINT HAS BEEN CLOSED AS UNCONFIRMED. IF THE PRODUCT IS RETURNED, SMITHS MEDICAL WILL REOPEN THIS COMPLAINT FOR FURTHER INVESTIGATION.

Description of Event or Problem · 0

IT WAS REPORTED THAT A NO DISPOSABLE CLAMP ALARM WAS EXPERIENCED. PATIENT NOT AFFECTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT A NO DISPOSABLE CLAMP ALARM WAS EXPERIENCED. PATIENT NOT AFFECTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
73029 CADD PUMP, INFUSION FRN ST PAUL 21-6500-51 10610586019647

Patients

Seq Age Sex Outcome Treatment
1 Unknown