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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: SMITHS MEDICAL ASD, INC. CADD ADMINISTRATION SETS - FLOW STOP; SET, ADMISTRATION, INTRVASCULAR

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SMITHS MEDICAL ASD, INC. CADD ADMINISTRATION SETS - FLOW STOP; SET, ADMISTRATION, INTRVASCULAR Back to Search Results
Model Number 7346
Device Problems Volume Accuracy Problem (1675); Insufficient Flow or Under Infusion (2182); Improper Flow or Infusion (2954)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 03/22/2021
Event Type  malfunction  
Event Description
Information was received indicating that during use of this smiths medical cadd administration sets, under delivery was noticed.It was reported that pump was supposed to be infused 2000ml over 24 hours, but 600 ml was left in the bag.The pump indicated that 2,000 ml was infused.Reported that the patient did not receive the full quantity of drug prescribed.No patient injury reported.
 
Event Description
Information was received indicating that during use of this smiths medical cadd solis vip pump, under delivery was noticed.It was reported that pump was supposed to infuse 750 ml over 24 hours.The pump showed 750 ml was infused but 240 ml was left in bag.Reported that the patient did not receive the full quantity of drug prescribed.No patient injury reported.
 
Manufacturer Narrative
This mdr was generated under protocol b10010116, as a result of warning letter cms# 617147.
 
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Brand Name
CADD ADMINISTRATION SETS - FLOW STOP
Type of Device
SET, ADMISTRATION, INTRVASCULAR
Manufacturer (Section D)
SMITHS MEDICAL ASD, INC.
6000 nathan lane north
minneapolis MN 55442
Manufacturer (Section G)
SMITHS MEDICAL ASD, INC.
6000 nathan lane north
minneapolis MN 55442
Manufacturer Contact
jim vegel
6000 nathan lane north
acb8.2030, unit 1280
minneapolis, MN 55442
MDR Report Key11721668
MDR Text Key247209156
Report Number3012307300-2021-03446
Device Sequence Number1
Product Code FPA
UDI-Device Identifier15019517161953
UDI-Public15019517161953
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K031361
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type User Facility
Reporter Occupation Other
Type of Report Initial,Followup,Followup
Report Date 02/21/2023
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 Number7346
Device Catalogue Number21-7346-24
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Was the Report Sent to FDA? No
Initial Date Manufacturer Received 03/25/2021
Initial Date FDA Received04/24/2021
Supplement Dates Manufacturer Received04/23/2021
02/09/2023
Supplement Dates FDA Received05/23/2021
02/21/2023
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Unknown
Patient Sequence Number1
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