FDA Adverse Event Malfunction Summary report: N

CADD SOLIS VIP PUMP

MDR report key: 14604495 · Received June 6, 2022

Report

Report Number
3012307300-2022-10820
Event Type
Malfunction
Date Received
June 6, 2022
Report Date
August 8, 2022
Manufacturer
SMITHS MEDICAL ASD, INC.
Product Code
FRN
UDI-DI
15019517150001
PMA / PMN Number
K111275
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

EVENT PROBLEM AND EVALUATION CODES: UPDATED DEVICE EVALUATION: THE DEVICE WAS RETURNED FOR INVESTIGATION. A VISUAL INSPECTION AND FUNCTIONAL TEST WERE PERFORMED. VISUAL INSPECTION FOUND THE DEVICE WAS MISSING THE TAMPER SEAL. THE CUSTOMER STATED PROBLEM WAS DUPLICATED. DURING INVESTIGATION, FOUND LATCH/LOCK OPTIC FLEX CIRCUIT NON-FUNCTIONING. REPLACED DEFECTIVE LATCHED OPTIC FLEX SENSOR. THE CAUSE OF THE REPORTED PROBLEM COULD NOT BE DETERMINED. A MANUFACTURING DHR REVIEW WAS NOT PERFORMED BECAUSE THE RESULTS OF THE COMPLAINT INVESTIGATION DO NOT INDICATE A PROBLEM WITH THE MANUFACTURE OR LAST REPAIR OF THE DEVICE. NO MANUFACTURING OR SERVICE ISSUES WERE IDENTIFIED AS CAUSES OF THE CUSTOMER'S REPORTED PROBLEM DURING THE REVIEW OF SERVICE AND REPAIR RECORDS. THEREFORE, NO MANUFACTURING OR SERVICE RECORDS REVIEW IS NEEDED.

Additional Manufacturer Narrative · 0

ADDITIONAL INFORMATION RECEIVED BY SMITHS MEDICAL/ICU ON 3-JUN-2022 VIA EMAIL AND ATTACHED TO COMPLAINT OBJECT: THE ISSUE WAS NOTED DURING USE WITH A PATIENT. THERE WAS NO PATIENT INJURY AS A RESULT. NO FURTHER INFORMATION IS AVAILABLE FROM THE CUSTOMER.

Description of Event or Problem · 0

ORACLE RO 1233076: IT WAS REPORTED THAT THE PUMP WAS NOT DETECTING THE CASSETTE. NO PATIENT INJURY WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
227026 CADD SOLIS VIP PUMP PUMP, INFUSION FRN SMITHS MEDICAL ASD, INC. 2120 15019517150001

Patients

Seq Age Sex Outcome Treatment
1 Unknown