IVENIX, INC.
Report
- Report Number
- 3014732157-2025-01001
- Event Type
- Malfunction
- Date Received
- September 15, 2025
- Date of Event
- February 21, 2024
- Report Date
- September 15, 2025
- Manufacturer
- FRESENIUS KABI USA, LLC
- Product Code
- FPA
- UDI-DI
- 00811505030054
- PMA / PMN Number
- K183311
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- VA, US
- Reporter Occupation
- OTHER HEALTH CARE PROFESSIONAL
- Health Professional
- Yes
Narratives
THE FOLLOWING HAS BEEN REPORTED: NON-CHEMO FLUID LEAKING FROM THE BACK OF THE CASSETTE. NO PATIENT HARM. DELAYED PATIENT INFUSION BY 15-20 MINUTES. A PRELIMINARY REVIEW OF THE LOGS COULD NOT BE PERFORMED. ONE SAMPLE OF IVENIX ADMINISTRATION SET WAS RETURNED FOR EVALUATION. DURING THE VISUAL INSPECTION IT WAS OBSERVED THAT THE SET WAS ASSEMBLED CORRECTLY PER THE APPLICABLE DRAWING. PRIMARY LINE INFUSION DID NOT PASS SUCCESSFULLY AND WAS TESTED WITH A SET RATE OF 0.5ML/HR AND SET VOLUME OF 1.5ML. A LEAK COMING FROM INSIDE OF THE CASSETTE WAS OBSERVED AND ALARM TUBING SET PROBLEM WAS REPLICATED TWICE IN THE IVENIX INFUSION MACHINE. AN UNDERWATER LEAK TEST WAS PERFORMED FOR VERIFYING THE LIQUID SIDE AREA OF CASSETTE AND BUBBLES WERE OBSERVED COMING FROM UNIT. AN UNDERWATER LEAK TEST WAS PERFORMED FOR VERIFYING THE AIR SIDE AREA OF THE CASSETTE AND NO BUBBLES WERE DETECTED. A DYE TEST WAS PERFORMED, AND IT WAS OBSERVED THAT THE LEAK WAS COMING FROM THE OUTLET VALVE. THE CUSTOMER COMPLAINT IS CONFIRMED. THE LEAK IN CASSETTE COULD BE POTENTIALLY RELATED TO A MISPLACED DIAPHRAGM WHICH RESULTED IN A LEAK WHEN THE DIAPHRAGM WAS ACTUATED BY THE VALVE PINS IN THE PUMP. IN ADDITION, IT COULD BE RELATED TO AN INCORRECT AND POOR SEALING OF THE CASSETTE IN THE WELDER MACHINE CAUSING THE GAP AND REPORTED LEAKAGE. FRESENIUS KABI HAS PERFORMED A RETROSPECTIVE REVIEW OF COMPLAINTS ASSOCIATED WITH THIS FAILURE MODE AND HAS DECIDED TO SUBMIT AN MDR AS A CONSERVATIVE MEASURE. NO ADVERSE EFFECTS WERE REPORTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1398632 | IVENIX, INC. | LVP PRIMARY ADMINISTRATION SET, DUAL-INLET, LOW-SORBING, NEEDLE-FREE PORT, Y-SIT | FPA | FRESENIUS KABI USA, LLC | SET-0013-1 | 00811505030054 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | NA | Unknown |