FDA Adverse Event Other Summary report: N

THERAKOS UVAR XTS PHOTOPHERESIS SYSTEM

MDR report key: 2011783 · Received February 22, 2011

Report

Report Number
2523595-2011-00008
Event Type
Other
Date Received
February 22, 2011
Date of Event
February 10, 2011
Report Date
February 22, 2011
Manufacturer
THERAKOS
Product Code
LNR
PMA / PMN Number
P860003
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MI, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

NO REPORTS OF A DEVICE MALFUNCTION HAVE BEEN RECEIVED TO DATE AS IT RELATES TO THIS EVENT. (B)(4).

Description of Event or Problem · 1

AT THE COMPLETION OF CYCLE 2, THE PATIENT COMPLAINED OF CHEST PAIN AND MILD SHORTNESS OF BREATH. PULSE OXIMITRY AND VITAL SIGNS WERE ALL WITHIN NORMAL RANGE. CUSTOMER STATED THAT THE PROCEDURE WAS ABORTED BECAUSE THE PATIENT IS FRAGILE. PATIENT WAS GIVEN 500ML BOLUS OF SALINE DISTRIBUTED OVER 1 HOUR AND WAS FINE AFTERWARDS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 THERAKOS UVAR XTS PHOTOPHERESIS SYSTEM XTS ECP TREATMENT LNR THERAKOS XTS

Patients

Seq Age Sex Outcome Treatment
1 Other METHOXSALEN: PER ECP TREATMENT| UVADEX: PER ECP TREATMENT, LOT #1935004