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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: SMITHS MEDICAL ASD, INC. CLEO® 90 INFUSION SET; SET, ADMINISTRATION, INTRAVASCULAR
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SMITHS MEDICAL ASD, INC. CLEO® 90 INFUSION SET; SET, ADMINISTRATION, INTRAVASCULAR Back to Search Results
Model Number 7230
Device Problem Fracture (1260)
Patient Problem Erythema (1840)
Event Date 12/03/2019
Event Type  malfunction  
Manufacturer Narrative
Event occurred in (b)(6).
 
Event Description
Information was received that a smiths medical cleo® 90 infusion catheter was used as a clysis in the patient's left arm, as per manufacturer's policy.The dressing and the clysis was then removed.It was noted that the clysis cannula was broken off as only 0.5cm attached.There was mild redness noted at the site, no edema, and the patient denied tenderness with palpation.There were no further reported adverse effects.
 
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Brand Name
CLEO® 90 INFUSION SET
Type of Device
SET, ADMINISTRATION, INTRAVASCULAR
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
dave halverson
6000 nathan lane north
minneapolis, MN 55442
7633833310
MDR Report Key9593524
MDR Text Key176676708
Report Number3012307300-2020-00235
Device Sequence Number1
Product Code FPA
UDI-Device Identifier10610586028397
UDI-Public10610586028397
Combination Product (y/n)N
Reporter Country CodeCA
PMA/PMN Number
K042172
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type foreign,user facility
Reporter Occupation Other
Type of Report Initial
Report Date 01/15/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received01/15/2020
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator No Information
Device Model Number7230
Device Catalogue Number21-7230-24
Was Device Available for Evaluation? No
Date Manufacturer Received12/19/2019
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 Initial
Patient Sequence Number1
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