MAUDE MDR 519181

MDR report key
519181
Report number
519181
Event key
0
Event type
3
Date of event
2003-11-05
Date received
2004-03-15
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Report source
U
Manufacturer link flag
N

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ASAHI APS HEMODIALYZERHEMODIALYZERNEXTRON MEDICALFKPAPS-105OSNAUNKNN
2RENATRONREPROCESSING DEVICEMINNTECH CORPLIFRS8330NAUNKNN

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12004-03-1501. O

Event Narratives#

D

Patient 1

PT EXPERIENCED CHILLS AND NAUSEA APPROX 150 MINUTES AFTER INITIATING HEMODIALYSIS THERAPY. THERAPY WAS PROVIDED WITH A 4TH-USE HEMODIALYZER.