FDA Adverse Event Malfunction Summary report: N

CADD SOLIS VIP

MDR report key: 14167542 · Received April 21, 2022

Report

Report Number
3012307300-2022-06795
Event Type
Malfunction
Date Received
April 21, 2022
Report Date
October 24, 2022
Manufacturer
ST PAUL
Product Code
MEA
UDI-DI
15019517099690
PMA / PMN Number
K170982
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

THE DEVICE WAS RETURNED TO SMITHS (ICU MEDICAL).

Additional Manufacturer Narrative · 0

OTHER, OTHER TEXT: H6: EVENT PROBLEM AND EVALUATION CODES: UPDATED. H3: DEVICE EVALUATED BY MANUFACTURER: UPDATED. H10: DEVICE EVALUATION: THE DEVICE WAS RETURNED FOR INVESTIGATION. VISUAL INSPECTION AND FUNCTIONAL TEST WERE PERFORMED. THE CUSTOMERS REPORTED PROBLEM WAS NOT RELATED TO ANY PREVIOUS REPAIR. VISUAL INSPECTION FOUND THAT THE PUMP HOUSING WAS SEPARATED DUE TO DAMAGE. THE REPORTED PROBLEM DID NOT PASS ACCURACY TEST, WAS NOT DUPLICATED. THREE ACCURACY TESTS WERE RAN, AND THE DEVICE WAS FOUND WITHIN SPECIFICATION RANGE OF ALL THREE TESTS. THUS, NO PROBLEM WAS FOUND RELATING TO ACCURACY. THE ROOT CAUSE OF THE REPORTED ISSUES WAS UNDETERMINED AS NO FAULT WAS FOUND. NO CORRECTIVE ACTION WAS TAKEN AS NO REPAIR WAS NEEDED. PRODUCT IS BEYOND A YEAR FROM MANUFACTURE DATE AND THERE WAS NO INDICATION OF A MANUFACTURING DEFECT DURING THE INVESTIGATION, SO A DEVICE HISTORY RECORD REVIEW IS NOT REQUIRED. SERVICE REVIEW IDENTIFIED THIS DEVICE HAS NOT BEEN IN FOR SERVICE PREVIOUSLY.

Additional Manufacturer Narrative · 0

ADDITIONAL INFORMATION WAS RECEIVED INDICATING THERE WAS NO PATIENT INVOLVEMENT; ISSUE WAS FOUND DURING PREVENTIVE MAINTENANCE.

Description of Event or Problem · 0

ORACLE RO 1221668: IT WAS REPORTED THAT THE PUMP DID NOT PASS ACCURACY TESTS. PATIENT INVOLVEMENT IS UNKNOWN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2418309 CADD SOLIS VIP PUMP, INFUSION MEA ST PAUL 2110 15019517099690

Patients

Seq Age Sex Outcome Treatment
1 Unknown