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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: SMITHS MEDICAL ASD, INC. CADD SOLIS HPCA PUMP; PUMP, INFUSION, PCA
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SMITHS MEDICAL ASD, INC. CADD SOLIS HPCA PUMP; PUMP, INFUSION, PCA Back to Search Results
Model Number 2110
Device Problem Device Alarm System (1012)
Patient Problem Insufficient Information (4580)
Event Date 03/01/2024
Event Type  malfunction  
Event Description
It was reported the device exhibited error 41622.There was unknown patient involvement.
 
Manufacturer Narrative
B3: unknown.One device was received for evaluation.Visual inspection found a damaged dso seal, scratched lens, and a damaged ac connector.Error 41622 was found in the event history log.Functional testing was able to verify and duplicate the reported problem.It was determined the root cause was from the motor and the pwa board.The motor and pwa were replaced.The service history review identified no indication that the complaint was related to a service of the device within the review period.
 
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Brand Name
CADD SOLIS HPCA PUMP
Type of Device
PUMP, INFUSION, PCA
Manufacturer (Section D)
SMITHS MEDICAL ASD, INC.
6000 nathan ln n
minneapolis MN 55442
Manufacturer Contact
reed covert
6000 nathan ln n
minneapolis, MN 55442
2247062300
MDR Report Key19112329
MDR Text Key340736932
Report Number3012307300-2024-02622
Device Sequence Number1
Product Code MEA
Combination Product (y/n)N
Reporter Country CodeFR
PMA/PMN Number
UNKNOWN
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Foreign,User Facility
Reporter Occupation Other Health Care Professional
Type of Report Initial
Report Date 04/15/2024
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Model Number2110
Device Catalogue Number21-2112-0200-02
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer03/19/2024
Is the Reporter a Health Professional? Yes
Initial Date Manufacturer Received 03/19/2024
Initial Date FDA Received04/15/2024
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured01/13/2011
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Reuse
Patient Sequence Number1
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