MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06,08 report with the FDA on 2003-02-19 for ASAHI AM-BIO SERIES DIALYZERS AM-BIO-100D NA manufactured by Asahi Medical Co., Ltd..
[315654]
A blood leak occurred around 1 minute after initiation of treatment. The dialyzer was at the initial use. The leak was observed with leak detector and visually. Blood loss volume was around 150cc, since the blood was not returned to the pt.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 8010002-2003-00013 |
| MDR Report Key | 444418 |
| Report Source | 06,08 |
| Date Received | 2003-02-19 |
| Date of Report | 2003-02-19 |
| Date of Event | 2003-01-21 |
| Date Mfgr Received | 2003-01-22 |
| Date Added to Maude | 2003-02-26 |
| 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 | MR. SEIICHI IIJIMA, GENERAL MANAGER |
| Manufacturer Street | 9-1, KANDA MITOSHIROCHO CHIYODA-KU |
| Manufacturer City | TOKYO 101-8482 |
| Manufacturer Country | JA |
| Manufacturer Postal | 101-8482 |
| Manufacturer Phone | 332595899 |
| 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 | ASAHI AM-BIO SERIES DIALYZERS |
| Generic Name | HEMODIALYZER |
| Product Code | MSE |
| Date Received | 2003-02-19 |
| Model Number | AM-BIO-100D |
| Catalog Number | NA |
| 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 | 433395 |
| Manufacturer | ASAHI MEDICAL CO., LTD. |
| Manufacturer Address | 9-1, KANDA MITOSHIROCHO CHIYODA-KU, TOKYO JA 101-8482 |
| Baseline Brand Name | ASAHI AM-BIO SERIES DIALYZERS |
| Baseline Generic Name | HEMODIALYZER |
| Baseline Model No | AM-BIO-100D |
| Baseline Device Family | ASAHI AM-BIO SERIES DIALYZER |
| Baseline Shelf Life Contained | Y |
| Baseline Shelf Life [Months] | 36 |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K983720 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2003-02-19 |