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 1999-12-01 for FILTRAL 20 FIL-20 manufactured by Hospal Industrie.
[16029832]
The pt became tachycardic and complained of nausea two to three minutes into the treatment. The pt was afebrile. The pt's symptoms quickly subsided and the treatment was completed without further complication. This was the second of three reactions with this pt.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 8010182-1999-00026 |
| MDR Report Key | 251801 |
| Report Source | 05,06,07 |
| Date Received | 1999-12-01 |
| Date of Report | 1999-11-01 |
| Date of Event | 1999-10-29 |
| Date Mfgr Received | 1999-11-01 |
| Date Added to Maude | 1999-12-02 |
| 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 ST |
| 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 | FILTRAL 20 |
| Generic Name | DIALYZER |
| Product Code | FJG |
| Date Received | 1999-12-01 |
| Model Number | NA |
| Catalog Number | FIL-20 |
| Lot Number | 99C1265 |
| 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 | 243871 |
| Manufacturer | HOSPAL INDUSTRIE |
| Manufacturer Address | 7, AVENUE LIONEL TERRAY MEYZIEU FR 69330 |
| 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. Other | 1999-12-01 |