ASAHI AM-BIO SERIES DIALYZERS AM-BIO-100 NA

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06,08 report with the FDA on 2003-04-14 for ASAHI AM-BIO SERIES DIALYZERS AM-BIO-100 NA manufactured by Asahi Medical Co., Ltd..

Event Text Entries

[16272681] A blood leak occurred 10 minutes after start of hemodialysis treatment. The dialyzer was at the initial reuse. The leak was observed with leak detector. Blood loss volume was around 200cc, since the blood was not returned to the patient. The patient was well and no medical treatment was given to the patient.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number8010002-2003-00030
MDR Report Key454521
Report Source06,08
Date Received2003-04-14
Date of Report2003-04-14
Date of Event2003-03-28
Date Mfgr Received2003-04-04
Device Manufacturer Date2003-01-01
Date Added to Maude2003-04-21
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location0
Manufacturer ContactMR. SEIICHI IIJIMA
Manufacturer Street9-1, KANDA MITOSHIROCHO CHIYODA-KU
Manufacturer CityTOKYO 101-8482
Manufacturer CountryJA
Manufacturer Postal101-8482
Manufacturer Phone32595892
Manufacturer G1*
Manufacturer Street*
Manufacturer City*
Manufacturer Country*
Single Use3
Previous Use Code3
Removal Correction NumberNA
Event Type3
Type of Report3

Device Details

Brand NameASAHI AM-BIO SERIES DIALYZERS
Generic NameHEMODIALYZER
Product CodeMSE
Date Received2003-04-14
Model NumberAM-BIO-100
Catalog NumberNA
Lot Number731K1QL
ID NumberNA
Device Expiration Date2006-01-24
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrY
Implant FlagN
Date RemovedA
Device Sequence No1
Device Event Key443523
ManufacturerASAHI MEDICAL CO., LTD.
Manufacturer Address9-1, KANDA MITOSHIROCHO CHIYODA-KU, TOKYO JA 101-8482
Baseline Brand NameASAHI AM-BIO SERIES DIALYZERS
Baseline Generic NameHEMODIALYZER
Baseline Model NoAM-BIO-100
Baseline Catalog NoNA
Baseline IDNA
Baseline Device FamilyASAHI AM-BIO SERIES DIALYZER
Baseline Shelf Life ContainedY
Baseline Shelf Life [Months]36
Baseline PMA FlagN
Baseline 510K PMNY
Premarket NotificationK983720
Baseline PreamendmentN
Baseline TransitionalN
510k ExemptN


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2003-04-14

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