MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 04 report with the FDA on 2003-05-28 for FREEDOM CYCLER PD+ PD+IQCARD NA manufactured by Fresenius Medical Care-north America.
[19553442]
The pt was overfilled during a ccpd treatment. The cycler was giving an alarm (type unknown) during dwell 1. The pt woke up and complained that their stomach hurts. Family member felt their abdomen and it was distended. Family member called the nurse and was advised to take the pt to the hosp where they were drained. The effluent was not measured but was estimated to be around 1700 ml. The pt's prescribed fill volume was 600 ml.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2937457-2003-00016 |
| MDR Report Key | 462723 |
| Report Source | 04 |
| Date Received | 2003-05-28 |
| Date of Report | 2003-04-29 |
| Date of Event | 2003-04-26 |
| Report Date | 2003-04-29 |
| Date Reported to Mfgr | 2003-04-29 |
| Date Mfgr Received | 2003-04-29 |
| Device Manufacturer Date | 2002-09-01 |
| Date Added to Maude | 2003-06-02 |
| 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 | 3 |
| Manufacturer Contact | ELVY DIZON, BSN, RN, CNN |
| Manufacturer Street | 2637 SHADELANDS DR |
| Manufacturer City | WALNUT CREEK CA 94598 |
| Manufacturer Country | US |
| Manufacturer Postal | 94598 |
| Manufacturer Phone | 9252950200 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | FREEDOM CYCLER PD+ |
| Generic Name | PERITONEAL DIALYSIS CYCLER |
| Product Code | KPF |
| Date Received | 2003-05-28 |
| Model Number | PD+IQCARD |
| Catalog Number | NA |
| Lot Number | NA |
| ID Number | NA |
| Operator | LAY USER/PATIENT |
| Device Availability | * |
| Device Age | 1 YR |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 451673 |
| Manufacturer | FRESENIUS MEDICAL CARE-NORTH AMERICA |
| Manufacturer Address | 2637 SHADELANDS DR WALNUT CREEK CA 94598 US |
| Baseline Brand Name | FREEDOM CYCLER PD+ |
| Baseline Generic Name | PERITONEAL DIALYSIS CYCLER |
| Baseline Model No | PD+IQCARD |
| Baseline Catalog No | NA |
| Baseline ID | NA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization | 2003-05-28 |