BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RENAL - DISPOSABLE

    MDR report key: 1893924 · Received November 9, 2010

    Report

    Report Number
    1423500-2010-05505
    Event Type
    Injury
    Date Received
    November 9, 2010
    Date of Event
    October 1, 2010
    Report Date
    October 17, 2010
    Product Code
    KDJ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). THE DEVICES INVOLVED IN THE INCIDENT WERE UNKNOWN. AS THE DATE OF ONSET OF THIS PERITONITIS EPISODE IS UNKNOWN AND PATIENT DISCARDED SUPPLIES AFTER EACH THERAPY, THE SAMPLE WAS NOT REQUESTED. A 510(K) NUMBER WILL NOT BE PROVIDED IN THE EMDR AS THE PRODUCT CODE AND LOT NUMBER ARE UNKNOWN. BAXTER HAS RECEIVED SIMILAR REPORTS FOR THE REPORTED PROBLEM. BAXTER WILL CONTINUE TO MONITOR SIMILAR REPORTS TO DETERMINE IF FURTHER ACTIONS ARE REQUIRED.

    Description of Event or Problem · 1

    ON (B)(6) 2010, THE PATIENT BEGAN PERITONEAL DIALYSIS (PD) TREATMENT. ON (B)(6) 2010, THE PATIENT WAS DIAGNOSED WITH PERITONITIS. ON THE SAME DAY, THE PD EFFLUENT SAMPLE WAS OBTAINED BEFORE THE START OF ANTIBIOTIC THERAPY. THE RESULT OF THE CULTURE WAS UNKNOWN AND THE PD EFFLUENT ANALYSIS WAS PENDING. THE PATIENT WAS NOT HOSPITALIZED FOR THE PERITONITIS BUT ON (B)(6) 2010 THE PATIENT BEGAN REMEDIAL THERAPY OF FORTUM (1GM, LOADING DOSE, INTRAPERITONEALLY (IP), FORTUM (1GM, DAILY, IP) CONTINUING, VANCOMYCIN (2GM, LOADING, IP), AND HEPARIN (2000 IU, DAILY, IP) CONTINUING. THE CAUSE OF THE PERITONITIS WAS UNKNOWN. ON AN UNKNOWN DATE IN (B)(6) 2010, THE CATHETER WAS REMOVED, AND PD THERAPY WAS DISCONTINUED AT THAT TIME. IT WAS NOT REPORTED WHETHER THE PERITONITIS RESOLVED. CONCOMITANT MEDICATIONS WERE NOT REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RENAL - DISPOSABLE SET, ADMINISTRATION, FOR PERITONEAL DIALYSIS, DISPOSABLE KDJ

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Required Intervention DIANEAL PD2 ULTRABAG