PROSORBA COLUMN 9798701

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2006-07-27 for PROSORBA COLUMN 9798701 manufactured by Fresenius Hemocare.

Event Text Entries

[19164390] Two days after her third prosorba treatment, the patient developed retrosternal chest pain. She had angiogram and a stent was placed in the rivp (right posterior descending coronary artery). She had a histroy of high cholesterol, hypertension and chest pain which improved with nitroglycerin. Prior to 2004 she had a diagnosis of posterior myocardial infarction and she had a stent place in the right coronary artery in 2004. This adverse event occurred in another country and we have been unable to obtain the lot number of the prosorba column used in the last treatment.
Patient Sequence No: 1, Text Type: D, B5


[19515318] 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 however the cause of her hypotension and electrolyte imbalance was not known and stated to possibly be due to a renal abnormality related to her underlying condition.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number3032792-2006-00009
MDR Report Key745034
Report Source05
Date Received2006-07-27
Date of Report2006-07-27
Date of Event2006-05-18
Report Date2006-07-25
Date Mfgr Received2006-06-27
Date Added to Maude2006-08-09
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 ContactJOSHUA LASKER
Manufacturer Street14715 NE 95TH ST. STE 100
Manufacturer CityREDMOND WA 98052
Manufacturer CountryUS
Manufacturer Postal98052
Manufacturer Phone4252422154
Manufacturer G1*
Manufacturer Street*
Manufacturer City*
Manufacturer Country*
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NamePROSORBA COLUMN
Generic NameIMMUNOADSORPTION
Product CodeLQQ
Date Received2006-07-27
Model Number9798701
Catalog Number9798701
Lot NumberUNK
ID NumberNA
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeUNKNOWN
Device Eval'ed by MfgrN
Implant FlagN
Date Removed*
Device Sequence No1
Device Event Key732822
ManufacturerFRESENIUS HEMOCARE
Manufacturer Address* REDMOND WA * US


Patients

Patient NumberTreatmentOutcomeDate
101. Hospitalization 2006-07-27

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