FDA Adverse Event Malfunction Summary report: N

UNKNOWN

MDR report key: 17533119 · Received August 12, 2023

Report

Report Number
MW5140024
Event Type
Malfunction
Date Received
August 12, 2023
Report Date
August 21, 2012
Manufacturer
FRESENIUS MEDICAL CARE NORTH AMERICA
Product Code
FKX
Report Source
Voluntary report
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 0

ON 11 JUN 2012, AN EMAIL NOTIFICATION OF A LEAK WAS RECEIVED IN THE BAXTER HEALTHCARE CORPORATE MAILBOX. A BAXTER-ASSOCIATE NOTIFIED BAXTER CORPORATE PRODUCT SURVEILLANCE OF A DEFECTIVE PERITONEAL SOLUTION BAG WHICH WAS FOUND IN THE ICU UNIT AT (B)(6) MEDICAL CENTER. THE CENTRAL SUPPLY SUPERVISOR WAS NOTIFIED THAT THE BAG WAS LEAKING. ON 30 JUL 2012, ADDITIONAL INFORMATION WAS OBTAINED STATING THAT THE DEFECTIVE PERITONEAL SOLUTION BAG HAD THE FOLLOWING NATIONAL DRUG CODE (NOC # 492302069) AND LOT # 115004009. ON 21 AUG 2012, A INTERNET SEARCH WAS CONDUCTED AND NOC NUMBER WAS IDENTIFIED FOR 49230-0206-92 AS OELFLEX LOW MAGNESIUM, LOW CALCIUM DEXTROSE DIALYSIS SOLUTION, 2000 MIS IN A 2 LITER BAG MANUFACTURED BY FRESENIUS MEDICAL CARE NORTH AMERICA.FDA APPLICATION NUMBER (B)(4). IT IS UNKNOWN WHETHER THERE WAS PATIENT INVOLVEMENT, PATIENT INJURY OR NECESSARY MEDICAL INTERVENTION. NO ADDITIONAL INFORMATION IS AVAILABLE. PATIENT INJURY REPORTED: YES, MEDICAL INTERVENTION REQUIRED: YES (B)(4). THIS REPORT REFLECTS INFORMATION RECEIVED BY FDA IN THE FORM OF A NOTIFICATION PER 803.22 (B)(2).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1074175 UNKNOWN SYSTEM, PERITONEAL, AUTOMATIC DELIVERY FKX FRESENIUS MEDICAL CARE NORTH AMERICA

Patients

Seq Age Sex Outcome Treatment
1 Unknown