MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,05 report with the FDA on 2006-06-15 for PROSORBA COLUMN 9798701 manufactured by Fresenius Hemocare.
[494176]
Ra pt admitted to hosp the evening after her 4th prosorba treatment with complaint of severe chest pain, substernal radiating down back, headache and earache. She was hypertensive with pulse 135 and mildly febrile on admission. D dimers were elevated and she was anemic. Ct scan, echo and stress tests were negative for pe and mi. Symptoms resolved and she was discharged after 3 days. Hematology consult performed after the event suggested she might have had a reaction to the citrate or heparin used during the procedure and for maintenance of central venous catheter patency. No further prosorba. Fresenius unable to obtain discharge summary from hosp.
Patient Sequence No: 1, Text Type: D, B5
[7785248]
This investigation is a clinical investigation only. Return of product not requested as evaluation of device after use not relevant to reported event. The device was used according to labeled indications and in the appropriate environment. Temporal relationship of the event and prosorba might suggest a contributory relationship.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 3032792-2006-00006 |
| MDR Report Key | 727490 |
| Report Source | 01,05 |
| Date Received | 2006-06-15 |
| Date of Report | 2006-06-15 |
| Date of Event | 2006-05-05 |
| Report Date | 2006-06-15 |
| Date Mfgr Received | 2006-05-16 |
| Device Manufacturer Date | 2005-04-01 |
| Date Added to Maude | 2006-06-22 |
| 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 | FRESENIUS HEMOCARE |
| Manufacturer Street | 14715 NE 95TH ST |
| 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 | 2006-06-15 |
| Model Number | 9798701 |
| Catalog Number | 9798701 |
| Lot Number | RDN001E |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | * |
| Device Age | 11 MO |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 715863 |
| 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 | 2006-06-15 |