PALL MEDICAL 791-03

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-05-04 for PALL MEDICAL 791-03 manufactured by Pall Corporation.

Event Text Entries

[74604843] Bmt lab technologists performed a cell wash procedure for an unrelated allogeneic hpc, cord blood unit on (b)(6) 2016 in preparation for distribution of the washer product for infusion into a recipient at (b)(6). After completing centrifugation of the product as required by the wash protocol, the technologists removed the centrifuge bucket from the centrifuge. Upon visually inspecting the cell wash/infusion bag of the wash set residing in the centrifuge bucket support insert, it was determined that fluid had leaked from the cell wash/infusion bag and was being contained in the support insert. Bmt lab technologists immediately notified the quality management supervisor and quality coordinator of the findings. The quality management supervisor and quality coordinator went to the clean room facility to assist in assessing the incident. Visual examination of the cell wash/infusion bag revealed a very small pin hole at the base of the cell wash/infusion bag above the heat seal. On visual inspection, it does not appear that the heat seal is involved. As a result of the pin hole, approx 5ml of the product with a tnc of 2. 17 x 10^7 was lost. Measures were initiated for cellular product rescue and wash of the remaining product using dextran was completed. Cellular product rescue resulted in a tnc recovery of 93 x 10^7 resulting in a tnc cell done for infusion of 11. 63 x 10^7/kg. As a result of the cell wash/infusion bag integrity failure, the sterility of the unit was compromised. After review of the findings and due to the medical necessity, it was determined by the pt's transplant physician to infuse the product. The product was infused on (b)(6) 2016 without incident. Sterility testing results are pending as of the date of this report 03/31/2016.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report NumberMW5069579
MDR Report Key6547340
Date Received2017-05-04
Date of Report2016-04-04
Date of Event2016-03-30
Date Added to Maude2017-05-05
Event Key0
Report Source CodeVoluntary report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NamePALL MEDICAL
Generic NameCELL WASH/INFUSION SET
Product CodeKSR
Date Received2017-05-04
Catalog Number791-03
Lot Number1253155
Device Expiration Date2018-09-01
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrI
Device Sequence No1
Device Event Key0
ManufacturerPALL CORPORATION
Manufacturer Address25 HARBOR PARK DRIVE FORT WASHINGTON NY 11050 US 11050


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2017-05-04

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