MAUDE MDR 4016926

MDR report key
4016926
Report number
2937457-2014-01838
Event key
0
Event type
3
Date of event
2014-04-20
Date received
2014-07-24
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
TANYA TAFT, RN CNOR
Address
920 WINTER ST. WALTHAM MA 02451 US
Phone
781-781-7816
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ASSY, CBTRK YBUTM FREEDOM CYCLER (REFURB)FRESENIUS MEDICAL CARE NORTH AMERICAKPFN N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-07-2401. H; 2. R

Event Narratives#

D

Patient 1

THE FOLLOWING WAS BASED ON MEDICAL RECORDS PROVIDED BY THE PATIENT'S TREATMENT FACILITY. THE PATIENT WAS HOSPITALIZED ON (B)(6) 2014 THROUGH (B)(6) 2014 DUE TO BACTERIAL AND FUNGAL PERITONITIS. THE PATIENT WAS TREATED WITH A 14 DAY COURSE OF CEFEPIME AND FLUCONAZOLE IP.

N

Patient 1

THE PATIENT WAS ADMITTED TO THE HOSPITAL ON (B)(6) 2014 THROUGH (B)(6) 2014 AFTER HIS MOTHER REPORTED A ONE DAY HISTORY OF CLOUDY, PURULENT EFFLUENT PERITONEAL DIALYSIS (PD) FLUID. THE PATIENT WAS HOSPITALIZED ON (B)(6) 2014 THROUGH (B)(6) 2014 DUE TO BACTERIAL AND FUNGAL PERITONITIS. DURING THIS TIME, HE COMPLETED A 14 DAY COURSE OF CEFEPIME AND FLUCONAZOLE INTRA-PERITONEALLY (IP) THROUGH HIS DIALYSATE. ON (B)(6) 2014 HIS EFFLUENT PD FLUID CULTURES WERE POSITIVE FOR ENTEROBACTER CLOACAE AND KLEBSIELLA PNEUMONIAE. ON (B)(6) 2014 AND (B)(6) 2014, PD FLUID CULTURES WERE POSITIVE. THE FOLLOWING WAS BASED ON MEDICAL RECORDS PROVIDED BY THE PATIENT'S TREATMENT FACILITY. HE COMPLETED A 14 DAY COURSE OF CEFEPIME AND FLUCONAZOLE INTRA-PERITONEALLY (IP) THROUGH HIS DIALYSATE. ON (B)(6) 2014 HIS EFFLUENT PD FLUID CULTURES WERE POSITIVE FOR ENTEROBACTER CLOACAE AND KLEBSIELLA PNEUMONIAE. ON (B)(6)2014 AND (B)(6) 2014, PD FLUID CULTURES WERE POSITIVE. THE FOLLOWING WAS BASED ON MEDICAL RECORDS PROVIDED BY THE PATIENT'S TREATMENT FACILITY. HE COMPLETED A 14 DAY COURSE OF CEFEPIME AND FLUCONAZOLE INTRAPERITONEALLY (IP). THE PATIENT HAS A HISTORY OF EMESIS WHICH HAS WORSENED RECENTLY AS WELL AS BASELINE LOOSE AND FREQUENT STOOLS. THE PATIENT WAS NEGATIVE FOR FEVER AND CHILLS. THE PATIENT'S ABDOMEN WAS NON-TENDER WITH NO REBOUND TENDERNESS OR GUARDING. THERE WERE NORMAL BOWEL SOUNDS. HIS GASTROSTOMY TUBE SITE WAS CLEAN AND DRY AND HIS PD CATHETER SHOWED NO SIGNS OF INFLAMMATION. THE PATIENT RECEIVED HIS LAST DOSE OF FLUCONAZOLE IN HIS PD FLUID ON (B)(6) 2014 AND DID NOT START HIS FLUCONAZOLE VIA HIS GASTROSTOMY TUBE UNTIL (B)(6) 2014. THE PATIENT'S LAST POSITIVE FUNGAL CULTURE IN THE PD FLUID WAS ON (B)(6) 2014 GROWING CANDIDA FUMATA. HIS LAST POSITIVE BACTERIAL CULTURE OF THE PD FLUID WAS ON (B)(6) 2014. A SUPPLEMENTAL REPORT WILL BE SUBMITTED UPON COMPLETION OF THE PLANT'S INVESTIGATION.