COBE SPECTRA TPE SET
Report
- Report Number
- 1722028-2012-00147
- Event Type
- Other
- Date Received
- March 13, 2012
- Date of Event
- February 13, 2012
- Report Date
- February 15, 2012
- Manufacturer
- CARIDIANBCT
- Product Code
- FRO
- PMA / PMN Number
- K020041
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- NC, US
- Reporter Occupation
- OTHER
Narratives
(B)(4). INVESTIGATION: PER THE CUSTOMER, THE PATIENT HAD RUN OUT OF HER MEDICATIONS THE FRIDAY BEFORE THE PROCEDURE, AND HAD NOT HAD THEM REFILLED. SHE WAS NOT ON ANY ACE INHIBITORS. THE PHYSICIANS AND THE PHARMACIST AT THE CUSTOMER SITE BELIEVE THE REACTION WAS RELATED TO THE ALBUMIN THE PATIENT RECEIVED. INVESTIGATION EVALUATION AND CORRECTIVE ACTIONS ARE IN-PROCESS. A FOLLOW-UP REPORT WILL BE PROVIDED.
(B)(4). THIS REPORT IS BEING FILED TO PROVIDE ADDITIONAL INFORMATION. THE DEVICE HISTORY RECORD WAS REVIEWED. NOTHING WAS FOUND THAT WAS RELATED TO THIS EVENT. ROOT CAUSE: AFTER EVALUATING ALL THE INFORMATION, THE PATIENT'S PHYSICIAN AND PHARMACIST DETERMINED THAT THE REACTION WAS RELATED TO THE ALBUMIN THE PATIENT RECEIVED. NO ISSUES WITH THE COBE SPECTRA SYSTEM WERE REPORTED BY THE CUSTOMER. ALLERGIC REACTIONS ARE A KNOWN POSSIBLE SIDE EFFECT OF APHERESIS PROCEDURES. ACCORDING TO THERAPEUTIC APHERESIS: A PHYSICIAN'S HANDBOOK, TRANSFUSION REACTIONS MAY OCCUR IN AS MANY AS (B)(4) OF PROCEDURES. THE COBE SPECTRA OPERATOR'S MANUAL WARNS OPERATORS THAT WHEN USING BIOLOGICALLY DERIVED REPLACEMENT FLUIDS, THE PATIENT SHOULD BE CLOSELY MONITORED FOR REACTIONS.
THE CUSTOMER REPORTED THAT 7 MINUTES INTO A THERAPEUTIC PLASMA EXCHANGE (TPE) PROCEDURE USING A 5% ALBUMIN AS THE REPLACEMENT SOLUTION, A NEW TPE PATIENT BEGAN HAVING HIVES. THE PROCEDURE WAS ENDED AND IV BENADRYL AND SOLUMEDROL WERE GIVEN FOR THE ALLERGIC REACTION. WITHIN AN HOUR THE HIVES RESOLVED. THE CUSTOMER DECLINED TO PROVIDE THE PATIENT IDENTIFIER, DATE OF BIRTH OR WEIGHT. THE DISPOSABLE SET IS UNAVAILABLE FOR RETURN BECAUSE THE CUSTOMER DISCARDED IT. THIS REPORT IS BEING FILED DUE TO MEDICAL INTERVENTION.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | COBE SPECTRA TPE SET | SEPARATOR, AUTOMATED, BLOOD CELL, DIAG | FRO | CARIDIANBCT | 01U15202 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other | ALBUMIN WAS PRE-BOTTLED FROM THE MANUFACTURER CSL| BEHRING IN 250ML BOTTLES. |