MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2005-04-07 for PROSORBA COLUMN 9798701 manufactured by Fresenius Hemocare.
[369013]
Patient admitted to hospital the evening after their 2nd pc treatment with fever chest pain and rash. Treatments had been done utilizing an interal jugular central line. Pt diagnosed with non-occlusive thrombus in the right internal jugular vein and pulmonary embolism. Central line discontinued, patient anticoagulated and discharged.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3032792-2005-00006 |
| MDR Report Key | 589749 |
| Report Source | 05 |
| Date Received | 2005-04-07 |
| Date of Event | 2005-03-14 |
| Date Facility Aware | 2005-03-14 |
| Device Manufacturer Date | 2004-08-01 |
| Date Added to Maude | 2005-04-12 |
| 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 | 3 |
| Event Location | 0 |
| Manufacturer Contact | KAREN QUARFORD |
| Manufacturer Street | 14787 NE 95TH STREET SUITE 100 |
| Manufacturer City | REDMOND WA 98052 |
| Manufacturer Country | US |
| Manufacturer Postal | 98052 |
| Manufacturer Phone | 4252422154 |
| Manufacturer G1 | FRESENIUM HEMOCARE |
| Manufacturer Street | 14787 NE 95TH STREET STE 100 |
| Manufacturer City | REDMOND WA 98052 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 98052 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PROSORBA COLUMN |
| Generic Name | PROSORBA COLUMN |
| Product Code | LQQ |
| Date Received | 2005-04-07 |
| Model Number | 9798701 |
| Catalog Number | 9798701 |
| Lot Number | QHN001D |
| ID Number | * |
| Device Expiration Date | 2005-02-28 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | U |
| Device Sequence No | 1 |
| Device Event Key | 579599 |
| Manufacturer | FRESENIUS HEMOCARE |
| Manufacturer Address | * REDMOND WA * US |
| Baseline Brand Name | PROSORBA COLUMN |
| Baseline Generic Name | THERAPEUTIC PLASMA EXCHA |
| Baseline Catalog No | 9798701 |
| Baseline Device Family | PROTEIN A IMMUNOADSORPTION COL |
| Baseline Shelf Life Contained | Y |
| Baseline Shelf Life [Months] | 12 |
| Baseline PMA Flag | Y |
| Premarket Approval | P8500 |
| Baseline 510K PMN | N |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization | 2005-04-07 |