BREATHTEK UBT KIT

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2016-09-29 for BREATHTEK UBT KIT manufactured by Otsuka America Pharmaceuticals, Inc..

Event Text Entries

[55995954] This spontaneous report was received from (b)(6) (b)(4) on (b)(6) 2016. Additional information received on 07-sep-2016 was combined with the initial. A consumer reported that on an unknown date in "2004 or 2006," after the female patient started the breathtek ubt kit (breathtek ubt kit), (unknown dose by mouth, one time dose), for helicobacter pylori urea breath test, she immediately experienced a "severe allergic reaction,"which required her to go to the emergency room. While she was in the emergency room she was given an "adrenaline shot;" after a few hours this "severe allergic reaction" resolved. This spontaneous report was received from (b)(6) (b)(4) on (b)(6) 2016. Additional information received on 07-sep-2016 was combined with the initial. The patient's medical history included irritable bowel syndrome, gluten sensitivity, allergy to cow's milk, allergy to grains, allergy to peanuts and tree nuts, allergy to whey protein allergy, and other products. She was on "other unknown concomitant medications. " diagnostic tests revealed the following results: unspecified test administered to determine lactose intolerance. She did not finish the breathtek test as she had the allergic reaction prior to the final sample collection. The consumer could not say for certain if the test had definitely caused her allergic reaction. Her physician wants to administer a breathtek ubt kit in the near future. The outcome of severe allergic reaction was recovered/resolved. The consumer could not say for certain the previous testing had definitively caused her allergic reaction. Otsuka causality assessment: the reported event allergic reaction is considered as related to breathtek ubt kit, given the temporal association and positive dechallenge, however the patient also had significant history of gluten sensitivity, allergy to cow's milk, allergy to grains, allergy to peanuts and tree nuts, allergy to whey protein allergy, and other products, which could have also contributed to the reported event. The information provided by the reporter is also not clear, as it was reported the event happened in 2004 or 2006 and the consumer could not say for certain if the previous testing caused allergic reaction, which precludes a meaningful medical assessment. Otsuka does not consider the information contained in this individual case safety report to justify any change to the benefit-risk balance of breathtek ubt kit or to justify any safety measures.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3000718406-2016-00002
MDR Report Key5988891
Date Received2016-09-29
Date of Report2016-09-02
Date Mfgr Received2016-09-02
Date Added to Maude2016-09-29
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactDR. MIRZA RAHMAN
Manufacturer Street1 UNIVERSITY SQUARE DRIVE, SUITE 500
Manufacturer CityPRINCETON NJ 08540
Manufacturer CountryUS
Manufacturer Postal08540
Manufacturer Phone6095359429
Manufacturer G1OTSUKA
Manufacturer Street2440 RESEARCH BLVD
Manufacturer CityROCKVILLE MD 20850
Manufacturer CountryUS
Manufacturer Postal Code20850
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameBREATHTEK UBT KIT
Generic NameUREA BREATH TEST (UBT) AND CALCULATION SOFTWARE
Product CodeMSQ
Date Received2016-09-29
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerOTSUKA AMERICA PHARMACEUTICALS, INC.
Manufacturer Address2440 RESEARCH BLVD ROCKVILLE MD 20850 US 20850


Patients

Patient NumberTreatmentOutcomeDate
101. Other; 2. Required No Informationntervention 2016-09-29

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