MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06,07 report with the FDA on 1999-07-16 for MULTIFLOW 60 USA FIL-20 manufactured by Hospal Industrie.
[158459]
The physician reported a possible reaction to the an69 membrane using an ak-10 pump. The system was blood-primed and the reaction occurred immediately at initiation of treatment. The treatment was discontinued and, after saline prime, resumed without further incident.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 8010182-1999-00016 |
| MDR Report Key | 232067 |
| Report Source | 05,06,07 |
| Date Received | 1999-07-16 |
| Date of Report | 1999-06-16 |
| Date Mfgr Received | 1999-06-16 |
| Date Added to Maude | 1999-07-20 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 0 |
| Manufacturer Contact | ROBBIN PROCOPIO, QA |
| Manufacturer Street | 1185 OAK STREET |
| Manufacturer City | LAKEWOOD CO 80215 |
| Manufacturer Country | US |
| Manufacturer Postal | 80215 |
| Manufacturer Phone | 3032314186 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MULTIFLOW 60 USA |
| Generic Name | DIALYZER |
| Product Code | FJG |
| Date Received | 1999-07-16 |
| Model Number | FIL-20 |
| Catalog Number | FIL-20 |
| Lot Number | UNK |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 224959 |
| Manufacturer | HOSPAL INDUSTRIE |
| Manufacturer Address | 7 AV. LIONEL TERRAY, B.P. 126 MEYZIEU CEDEX FR F-69883 |
| Baseline Brand Name | AN69 HOLLOW FIBER DIALYZER |
| Baseline Generic Name | CAVH/D HEMOFILTRATION |
| Baseline Model No | NA |
| Baseline Catalog No | FIL-20 |
| Baseline ID | NA |
| Baseline Device Family | HEMOFILTRATION |
| Baseline Shelf Life Contained | Y |
| Baseline Shelf Life [Months] | 36 |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K901368 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 1999-07-16 |