MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2017-10-13 for MARS 800541 manufactured by Baxter Healthcare - Rostock.
[90312193]
Should additional relevant information become available, a supplemental report will be submitted.
Patient Sequence No: 1, Text Type: N, H10
[90312194]
During priming of the mars device, the user noticed a leak in the tubing set at the connection site to the mars filter. The user was not able to complete the priming set up. The user took the whole set down and used another new set for priming and patient treatment. There was no patient involvement. No additional information is available.
Patient Sequence No: 1, Text Type: D, B5
[115701404]
Additional information: lot number. A batch review was conducted and there were no deviations found related to this reported condition during the manufacture of this lot. The actual device was not received for evaluation; however, a video and photos were provided. The visual inspection of the provided photos and video confirms the failure description of the user. The disconnection between hansen connector and corresponding line is clearly visible and caused by an insufficient gluing. A nonconformance has been opened to address this issue. Should additional relevant information become available, a supplemental report will be submitted.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 3007697864-2017-00058 |
| MDR Report Key | 6950112 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2017-10-13 |
| Date of Report | 2017-11-21 |
| Date of Event | 2017-09-17 |
| Date Facility Aware | 2017-09-19 |
| Report Date | 2017-10-13 |
| Date Reported to FDA | 2017-10-13 |
| Date Reported to Mfgr | 2017-10-13 |
| Date Mfgr Received | 2017-11-17 |
| Date Added to Maude | 2017-10-13 |
| 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 Street | 25212 W. ILLINOIS ROUTE 120 |
| Manufacturer City | ROUND LAKE IL 60073 |
| Manufacturer Country | US |
| Manufacturer Postal | 60073 |
| Manufacturer Phone | 2242702068 |
| Manufacturer G1 | BAXTER HEALTHCARE - ROSTOCK |
| Manufacturer Street | FRIEDRICH-BARNEWITZ-STRASSE 4 |
| Manufacturer City | ROSTOCK 18119 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 18119 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MARS |
| Generic Name | APPARATUS, HEMOPERFUSION, SORBENT |
| Product Code | FLD |
| Date Received | 2017-10-13 |
| Model Number | NA |
| Catalog Number | 800541 |
| Lot Number | 0000022597 |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BAXTER HEALTHCARE - ROSTOCK |
| Manufacturer Address | ROSTOCK |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-10-13 |