MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,05,06,08 report with the FDA on 2014-08-06 for PURECEPTION 80 PERCENT LOWER PHASE GRADIENT ART-2080 manufactured by Sage In-vitro Fertilization Inc..
[4865864]
"we have received complaint from the (b)(6) that in one of our sperm laboratory unit, three women where insemination (iui) from sperm donations and almost immediately after injection (after half an hour) developed intense pain in the lower abdomen and leukocytes from 14 to 18 thousand, the sperm donations were from different donors, there were no similar cases in the past, the injection was prepared by different employees and medical staff believes that due to the rapid development of symptoms it seemed to them that the cause is not a bacterial infection but rather a toxic response. "
Patient Sequence No: 1, Text Type: D, B5
[11917519]
(b)(4).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2031459-2014-00003 |
| MDR Report Key | 4058319 |
| Report Source | 01,05,06,08 |
| Date Received | 2014-08-06 |
| Date of Report | 2014-07-15 |
| Date of Event | 2014-07-15 |
| Date Mfgr Received | 2015-07-15 |
| Device Manufacturer Date | 2013-07-16 |
| Date Added to Maude | 2014-09-05 |
| 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 | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | NANA BANAFO |
| Manufacturer Street | 75 CORPORATE DR |
| Manufacturer City | TRUMBULL CT 06611 |
| Manufacturer Country | US |
| Manufacturer Postal | 06611 |
| Manufacturer Phone | 2036015200 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PURECEPTION 80 PERCENT LOWER PHASE GRADIENT |
| Generic Name | PURECEPTION MEDIA |
| Product Code | MQL |
| Date Received | 2014-08-06 |
| Catalog Number | ART-2080 |
| Lot Number | D197C |
| Device Expiration Date | 2015-07-16 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SAGE IN-VITRO FERTILIZATION INC. |
| Manufacturer Address | PASADENA CA US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2014-08-06 |