MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2005-11-15 for PROSORBA COLUMN 9798701 manufactured by Fresenius Hemocare.
[424512]
An ra patient was admitted to the hospital after her 10th prosorba treatment with chest pain and hypotension. She later underwent an angioplasty. She has a history of coronary artery disease but neither the rheumatologist or apheresis personnel were aware of any details regarding it. She had recently been taken off an ace inhibitor due to prosorba treatments. Her rheumatologist was unable to obtain any records from the hospital regarding her treatment for this adverse event.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3032792-2005-00019 |
| MDR Report Key | 646533 |
| Report Source | 05 |
| Date Received | 2005-11-15 |
| Date of Report | 2005-11-15 |
| Date of Event | 2005-10-14 |
| Report Date | 2005-11-05 |
| Date Mfgr Received | 2005-10-18 |
| Device Manufacturer Date | 2005-01-01 |
| Date Added to Maude | 2005-11-18 |
| 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 | 3 |
| Manufacturer Contact | JOSHUA LASKER |
| Manufacturer Street | 14715 NE 95TH ST, STE 100 |
| Manufacturer City | REDMOND WA 98052 |
| Manufacturer Country | US |
| Manufacturer Postal | 98052 |
| Manufacturer Phone | 4252422154 |
| Manufacturer G1 | FRESENIUS HEMOCARE |
| Manufacturer Street | 14715 NE 95TH ST, 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 | IMMUNOADSORPTION COLUMN |
| Product Code | LQQ |
| Date Received | 2005-11-15 |
| Model Number | 9798701 |
| Catalog Number | 9798701 |
| Lot Number | RAN002C |
| ID Number | NA |
| Device Expiration Date | 2006-07-30 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | 9 MO |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 636040 |
| 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 | 2005-11-15 |