BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CADD SOLIS VIP PUMP

    MDR report key: 20714065 · Received November 18, 2024

    Report

    Report Number
    3012307300-2024-13528
    Event Type
    Malfunction
    Date Received
    November 18, 2024
    Date of Event
    October 1, 2024
    Report Date
    November 18, 2024
    Manufacturer
    SMITHS MEDICAL ASD, INC.
    Product Code
    FRN
    UDI-DI
    10610586042829
    PMA / PMN Number
    K111275
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    E1: PHONE EX (B)(6). ONE DEVICE WAS RECEIVED FOR EVALUATION. FUNCTIONAL TESTING FOUND WAS ABLE BE REPLICATED WHEN ATTACHED CASSETTE AND CLOSED LATCHED LOCKED HANDLE. THE MOST LIKELY CAUSE OF THE REPORTED ERROR IS FAULTY MAIN BOARD CAUSING DRIFTING READINGS ON DOWNSTREAM OCCLUSION (DSO) VALUE IN MAIN MENU AND FLUID INGRESSION FOUND ON DSO SENSOR ASSEMBLY. THE SERVICE HISTORY REVIEW HAD NO INDICATION THAT THE COMPLAINT WAS RELATED TO A SERVICE OF THE DEVICE WITHIN THE REVIEW PERIOD.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT THE DEVICE EXHIBITED A CASSETTE DETECT ERROR. THERE WAS UNKNOWN PATIENT INVOLVEMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2591963 CADD SOLIS VIP PUMP PUMP, INFUSION FRN SMITHS MEDICAL ASD, INC. 2120 10610586042829

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown