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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: SMITHS MEDICAL ASD, INC. CADD MS3 PUMP HOLDER; ACCESSORIES, PUMP, INFUSION

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SMITHS MEDICAL ASD, INC. CADD MS3 PUMP HOLDER; ACCESSORIES, PUMP, INFUSION Back to Search Results
Device Problems Break (1069); Defective Device (2588)
Patient Problem Pain (1994)
Event Type  Injury  
Event Description
Pt requesting a new pump holder, we just sent her one but she states it is defective, hurts and is falling apart.Pt also requested pharmacist consult regarding new dose, unk sn number for defective pump holder.Reported to (b)(4) by pt/caregiver.
 
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Brand Name
CADD MS3 PUMP HOLDER
Type of Device
ACCESSORIES, PUMP, INFUSION
Manufacturer (Section D)
SMITHS MEDICAL ASD, INC.
MDR Report Key10785557
MDR Text Key214798637
Report NumberMW5097632
Device Sequence Number1
Product Code MRZ
Combination Product (y/n)Y
Number of Events Reported1
Summary Report (Y/N)N
Report Source Voluntary
Reporter Occupation Other Health Care Professional
Type of Report Initial
Report Date 10/29/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received11/03/2020
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Device Operator No Information
Is the Reporter a Health Professional? Yes
Patient Sequence Number1
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