MAUDE Adverse Event Report: SMITHS MEDICAL ASD, INC. PORTEX® SPINAL ANESTHESIA TRAY; ANESTHESIA CONDUCTION KIT

Catalog Number NEPI-NLD-15583C-21

Device Problem Defective Component (2292)

Patient Problem Pain (1994)

Event Date 12/04/2017

Event Type  malfunction  

Manufacturer Narrative

Potential lot number: 3504495.

Event Description

It was reported that a portex® spinal anesthesia tray was not effective.The patient reported no relief.The patient was given intravenous centenol in order to alleviate pain.No permanent injury was reported.

Manufacturer Narrative

No device was returned for evaluation.A review of the device history record, incoming record, and sterilization certificate found no discrepancies.Assay testing was performed on the drug lot by the supplier and found that the product was processed according to validated specifications.Based on the evidence, no fault was able to be confirmed.

• Brand Name: PORTEX® SPINAL ANESTHESIA TRAY
• Type of Device: ANESTHESIA CONDUCTION KIT
• Manufacturer (Section D): SMITHS MEDICAL ASD, INC.; 6000 nathan lane north; minneapolis MN 55442
• Manufacturer (Section G): SMITHS MEDICAL NORTH AMERICA; 10 bowman drive; keene NH 03431 0724
• Manufacturer Contact: dave halverson ; 6000 nathan lane north; minneapolis, MN 55442 ; 7633833310
• MDR Report Key: 7117936
• MDR Text Key: 94948840
• Report Number: 3012307300-2017-02571
• Device Sequence Number: 1
• Product Code: CAZ
• UDI-Device Identifier: 15019517115680
• UDI-Public: 15019517115680
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: user facility
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 02/07/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/14/2017
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Catalogue Number: NEPI-NLD-15583C-21
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 01/17/2018
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: N
• Patient Sequence Number: 1
• Patient Age: 60 YR
• Patient Weight: 76