MAUDE Adverse Event Report: SMITH & NEPHEW MEDICAL LTD. PICO 14 10CM X 30CM US; NEGATIVE PRESSURE WOUND THERAPY POWERED SUCTION PUMP

Catalog Number	66022043
Medical Device Problem Code	Pumping Stopped (1503)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	10/07/2020
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that in a pico 14 10x30, all lights illuminated on pump.No harm or injury reported on patient.A smith and nephew back up device was used instead.It is unknown if there was any delay.
Additional Manufacturer Narrative
H6,h10: we have now concluded our investigation for the complaint received.A review of the associated batch manufacturing records did not identify any issue at the point of manufacture which may have caused or contributed to the issue highlighted by the complainant.In addition it can be confirmed that all finished product specification testing was satisfied at the point of release.The complaint history file does not contain further instances/ related events of the reported event.The device was intended for use in treatment.The returned device was evaluated.An initial visual inspection did not identify any issues.When fresh batteries were inserted the device functioned without issue.No device errors were identified.The ifu outlines application and set-up steps.Issues during application may have contributed to the reported issue.We have not been able to confirm a relationship between the event and the device.The investigation has been closed as no device problem found.No further actions by smith and nephew are deemed necessary at this stage.However, we will continue to monitor for any adverse trends relating to this product range.Smith and nephew acknowledge customer concern and are continually investigating ways to develop and improve our products.

• Brand Name: PICO 14 10CM X 30CM US
• Common Device Name: NEGATIVE PRESSURE WOUND THERAPY POWERED SUCTION PUMP
• Manufacturer (Section D): SMITH & NEPHEW MEDICAL LTD.; 101 hessle road; hull east riding of yorkshire HU3 2 BN; UK HU3 2BN
• MDR Report Key: 10788019
• Report Number: 8043484-2020-03735
• Device Sequence Number: 14180193
• Product Code: OMP
• UDI-Device Identifier: 05000223495398
• UDI-Public: 5000223495398
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K191760
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: health professional,user faci
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 12/10/2020

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
• Operator of Device: Health Professional
• Device Catalogue Number: 66022043
• Device Lot Number: 1950
• Initial Date Received by Manufacturer: 10/07/2020
• Supplement Date Received by Manufacturer: 12/09/2020
• Initial Report FDA Received Date: 11/04/2020
• Supplement Report FDA Received Date: 12/10/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1