MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2006-06-01 for PROSORBA COLUMN 9798701 manufactured by Fresenius Hemocare.
[15702863]
Patient developed hive-like rash, chest tightness and sob 4 hours after 6th prosorba. She was admitted to hospital and treated for anaphylaxis. She was administered iv steroids, epinephrine and benadryl and admitted to the icu overnight for observation. Symptoms resolved and patient was discharged the next day. Fhc's medical consultant, a rheumatologist, described this event as an immune complex mediated "anaphylaxoid" reaction due to cryoglobulin spikes and complement activation.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3032792-2006-00005 |
| MDR Report Key | 722406 |
| Report Source | 05 |
| Date Received | 2006-06-01 |
| Date of Report | 2006-06-01 |
| Date of Event | 2006-05-03 |
| Date Facility Aware | 2006-05-04 |
| Report Date | 2006-06-01 |
| Date Mfgr Received | 2006-05-04 |
| Device Manufacturer Date | 2005-07-01 |
| Date Added to Maude | 2006-06-06 |
| 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. SUITE 100 |
| Manufacturer City | REDMOND WA 98052 |
| Manufacturer Country | US |
| Manufacturer Postal | 98052 |
| Manufacturer Phone | 4252422154 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| 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 | 2006-06-01 |
| Model Number | 9798701 |
| Catalog Number | 9798701 |
| Lot Number | RGN001A |
| ID Number | NA |
| Device Expiration Date | 2007-01-01 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | 10 MO |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 711473 |
| 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 | 2006-06-01 |