MAUDE MDR 7992322

MDR report key
7992322
Report number
3010668881-2018-00002
Event key
0
Event type
3
Date of event
2018-09-28
Date received
2018-10-22
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Address
46 NATSUMEGAICHI, AONO AYABE, KYOTO 623-8 JA
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1NEOVEILSTAPLE LINE REINFORCEMENT MATERIALGUNZE LIMITEDOXCNV-L-015GNV-L-015G18030401R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-10-2201. L

Event Narratives#

N

Patient 1

JUDGING FROM THE SITUATION OF TREATMENT, THE CAUSE OF ANAPHYLAXIS IS CONSIDERED TO BE EITHER NEOVEIL OR FIBRIN GLUE. SINCE FIBRIN GLUE CONTAINS HETEROLOGOUS PROTEINS AND WARNINGS RELATED TO ANAPHYLAXIS IS DESCRIBED IN IFU OF FIBRIN GLUE, WE BELIEVE THAT IT IS HIGHLY POSSIBLE THAT FIBRIN GLUE IS THE CAUSE. HOWEVER, THE TEST TO IDENTIFY THE ALLERGEN WAS NOT CARRIED OUT, SO IT WAS NOT POSSIBLE TO PROVE THAT NEOVEIL WAS NOT THE CAUSE.

D

Patient 1

ON (B)(6) 2018: PARTIAL RESECTION WAS PERFORMED ON UPPER LEFT LOBE CANCER (PRIMARY). AS TREATMENT FOR LUNG FISTULA, NEOVEIL WAS APPLIED TO LUNG CANCER RESECTED AREA WITH 5 ML FIBRIN GLUE ("BOLHEAL" KM BIOLOGICS CO.LTD. LOT NUMBER H 5717). BLOOD PRESSURE DECREASED AND FACIAL FLUSH OCCURRED 10 TO 15 MINUTES AFTER APPLICATION. THERE WAS NO RASH. BOTH THE ANESTHESIOLOGIST AND SURGEON DETERMINED THAT ANAPHYLACTIC SHOCK WAS CAUSED BY EITHER NEOVEIL OR BOLHEAL. 0.3 MG OF ADRENALINE INTRAMUSCULARLY, 5 MG OF POLARAMINE INTRAVENOUSLY, NEOVEIL WAS REMOVED AND THE SURGICAL FIELD WAS WASHED WITH PHYSIOLOGICAL SALINE. THE PATIENT RECOVERED THE SAME DAY. ON (B)(6) 2018: THE PATIENT WAS DISCHARGED FROM THE HOSPITAL THE PATIENT HAS THE FOLLOWING OPERATION HISTORY, USING NEOVEIL AND FIBRIN GLUE ("BERIPLAST" CSL BEHRING) AT THAT TIME. IN (B)(6) 2017, RIGHT MIDDLE LOBE LUNG CANCER WAS RESECTED. AT THAT TIME, NEOVEIL (NV-L-015G, LOT NUMBER UNKNOWN) WAS PASTED WITH 5 ML OF BERIPLAST (LOT NUMBER UNKNOWN).