CWP 100 CENTRAL WATER TREATMENT SYSTEM 104 H

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a user facility report with the FDA on 2018-03-28 for CWP 100 CENTRAL WATER TREATMENT SYSTEM 104 H manufactured by Mar Cor Purification.

Event Text Entries

[103775232] A facility reported while a patient care technician was disconnecting the acid connections from the dialysis wall box used with their cwp 100 central water treatment system, the connector fitting released and the technician's hand hit the base of the wall box causing nerve damage in his hand. The technician was reported to be out of work for one week as a result of the reported hand injury. Mar cor regulatory affairs followed up with the facility's technical manager and he reported he has trained the facility staff how to disconnect the connections from the wallboxes to avoid hitting their hands when the connection fitting releases. The injured employee is reported to be back at work and is doing fine. This complaint will continue being monitored in the mar cor purification complaint handling system.
Patient Sequence No: 1, Text Type: N, H10


[103775233] A facility reported while a patient care technician was disconnecting the acid connections from the dialysis wall box used with their cwp 100 central water treatment system, the technician hit his hand on the base of the wall box, causing nerve damage in his hand. The technician was reported to be out of work for one week as a result of the reported hand injury.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3019131-2018-00001
MDR Report Key7380079
Report SourceUSER FACILITY
Date Received2018-03-28
Date of Report2018-03-28
Date of Event2018-02-28
Date Mfgr Received2018-02-28
Device Manufacturer Date2017-07-19
Date Added to Maude2018-03-28
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactALEX NELSON
Manufacturer Street14550 28TH AVE N
Manufacturer CityPLYMOUTH MN 55447
Manufacturer CountryUS
Manufacturer Postal55447
Manufacturer Phone7635094799
Manufacturer G1MAR COR PURIFICATION
Manufacturer Street14550 28TH AVE. N.
Manufacturer CityPLYMOUTH MN 55447
Manufacturer CountryUS
Manufacturer Postal Code55447
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameCWP 100 CENTRAL WATER TREATMENT SYSTEM
Generic NameWATER PURIFICATION SYSTEM FOR HEMODIALYSIS
Product CodeFIP
Date Received2018-03-28
Model Number104 H
Device AvailabilityY
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerMAR COR PURIFICATION
Manufacturer Address14550 28TH AVENUE NORTH PLYMOUTH MN 55447 US 55447


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2018-03-28

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