FDA Adverse Event Injury Summary report: N

COMBI SET

MDR report key: 1843806 · Received September 21, 2010

Report

Report Number
8030665-2010-00024
Event Type
Injury
Date Received
September 21, 2010
Report Date
September 22, 2010
Manufacturer
REYNOSA MANUFACTURING
Product Code
FJK
PMA / PMN Number
K962081
Removal / Correction Number
NA
Report Source
Manufacturer report
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

A MEDWATCH REPORT HAS BEEN RECEIVED FROM FDA. THE FACILITY HAS BEEN CONTACTED FOR ADDITIONAL INFORMATION ON THIS EVENT. IN SPEAKING WITH THE REPORTER OF THE EVENT, THE FOLLOWING ADDITIONAL INFORMATION WAS OBTAINED. THAT THE PATIENT WAS OBSERVED EVERY 15 MINUTES UP UNTIL THE EVENT OCCURRED. REPORTEDLY, THE RN HAD LEFT THE PATIENT'S BEDSIDE TO GET MEDICATIONS AND FOUND THE PATIENT TO BE DISCONNECTED UPON HER RETURN. IT WAS ALSO REPORTED THAT THE PATIENT SUCCESSFULLY RECEIVED 2 HOURS OF DIALYSIS WITH USE OF THESE BLOODLINES PRIOR TO THE EVENT WITH NO REPORT OF ANY DIFFICULTY TO USE. A CATHETER TO BLOODLINE SAFETY DEVICE WAS NOT USED. CURRENTLY, IT HAS BEEN LEARNED THAT THIS PATIENT'S HEALTH STATUS IS IMPROVING AND SHE IS EXPECTED TO BE DISCHARGED. OF NOTE: IT IS CONFIRMED THAT NO DEATH OCCURRED AS WAS INITIALLY REPORTED AND NOTED ON THE MEDWATCH REPORT AND THAT THE EVENT IS A DISCONNECTION. THE REPORTER WAS NOT SURE IF THE NURSE HAD INSPECTED THE LINES OR CONNECTOR AREAS PRIOR TO DISCARDING THEM.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 COMBI SET NONE FJK REYNOSA MANUFACTURING NA UNK

Patients

Seq Age Sex Outcome Treatment
1 Other| R