MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a user facility report with the FDA on 2017-12-29 for F8 DIALYZER FINISHED ASSY (CASE) 0500164A manufactured by Ogden Manufacturing Plant.
[96112849]
A supplemental medwatch report will be submitted upon completion of the investigation.
Patient Sequence No: 1, Text Type: N, H10
[96112850]
A user facility administrator reported experiencing problems with a dialyzer during hemodialysis treatment, and stated the membranes of the dialyzer were breaking upon use and that the filter was being rejected by the system due to pressure failure. Blood loss was also reported. Additional information was requested and was not received to date.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1713747-2017-00414 |
| MDR Report Key | 7154605 |
| Report Source | USER FACILITY |
| Date Received | 2017-12-29 |
| Date of Report | 2018-04-16 |
| Date of Event | 2017-11-28 |
| Date Mfgr Received | 2018-04-16 |
| Device Manufacturer Date | 2017-01-16 |
| Date Added to Maude | 2017-12-29 |
| 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 | THOMAS C. JOHNSON |
| Manufacturer Street | 920 WINTER ST. |
| Manufacturer City | WALTHAM MA 02451 |
| Manufacturer Country | US |
| Manufacturer Postal | 02451 |
| Manufacturer Phone | 7816999499 |
| Manufacturer G1 | OGDEN MANUFACTURING PLANT |
| Manufacturer Street | 475 WEST 13TH STREET |
| Manufacturer City | OGDEN UT 84404 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 84404 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | F8 DIALYZER FINISHED ASSY (CASE) |
| Generic Name | DIALYZER, CAPILLARY, HOLLOW FIBER |
| Product Code | FJI |
| Date Received | 2017-12-29 |
| Catalog Number | 0500164A |
| Lot Number | 17AU04014 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | MO |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | OGDEN MANUFACTURING PLANT |
| Manufacturer Address | 475 WEST 13TH STREET OGDEN UT 84404 US 84404 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-12-29 |