BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MINICAP

    MDR report key: 2822987 · Received November 7, 2012

    Report

    Report Number
    1416980-2012-04309
    Event Type
    Malfunction
    Date Received
    November 7, 2012
    Date of Event
    October 12, 2012
    Report Date
    October 23, 2012
    Manufacturer
    BAXTER HEALTHCARE - CLEVELAND
    Product Code
    KDI
    PMA / PMN Number
    K895631
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER CAREGIVERS

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). A BATCH REVIEW WAS CONDUCTED AND NO ISSUES WERE FOUND RELATED TO THE REPORTED CONDITION DURING THE MANUFACTURE OF THE LOT. A REQUEST FOR THE RETURN OF THE DEVICE HAS BEEN MADE. SHOULD THE DEVICE BE RECEIVED BY BAXTER FOR EVALUATION, A FOLLOW-UP REPORT WILL BE FILED UPON COMPLETION OF AN EVALUATION OR IF ANY ADDITIONAL INFORMATION BECOMES AVAILABLE.

    Additional Manufacturer Narrative · 1

    (B)(4). THE REPORTED PROBLEM OF CONNECTION ISSUE WAS NOT CONFIRMED BECAUSE NO SAMPLES WERE RETURNED TO BAXTER FOR ANALYSIS. A ROOT CAUSE WAS UNDETERMINED.

    Description of Event or Problem · 1

    THE CAREGIVER (CG) CONTACTED PRODUCT SURVEILLANCE TO REPORT LOOSE MINICAPS ON THE TRANSFER SET. THE CG STATED THAT THE HOME PATIENT (HP) WENT TO THE CLINIC ON (B)(6) 2012 TO HAVE HIS 6 MONTH TRANSFER SET CHANGED OUT. THE CG SAID THAT WHEN THE HP WENT TO REMOVE THE MINICAP FOR THERAPY THAT NIGHT, IT WAS LOOSE. THE HP TRIED 2 DIFFERENT LOT NUMBERS OF MINICAPS AND SOME MINICAPS FROM THE CLINIC BUT THE ALL THE MINICAPS WERE FOUND TO BE LOOSE AND CONTINUED TO BE FROM (B)(6) 2012 (THIS REPORT IS COVERING THE (B)(6) 2012 OCCURRENCE WITH A MINICAP FROM THE FIRST LOT NUMBER, GD892380). THE CG SAID THE HP WENT TO THE CLINIC ON (B)(6) 2012 TO HAVE THE TRANSFER SET CHANGED OUT AGAIN. THE CG SAID THAT SHE WOULD RETURN A MINICAP FROM BOTH REPORTED LOT NUMBERS AND A MINICAP FROM THE CLINIC, IF SHE COULD FIND ONE. THERE WAS NO PATIENT INJURY OR MEDICAL INTERVENTION INDICATED AT THE TIME OF THE INITIAL REPORT. THERE WAS PATIENT INVOLVEMENT. PRODUCT SURVEILLANCE CONTACTED THE HOME PATIENT'S (HP) REGISTERED NURSE (RN) ON (B)(4) 2012 REGARDING THE LOOSE MINICAPS. THE RN DID NOT HAVE ANY OF THE MINICAPS TO RETURN. NO ADDITIONAL INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MINICAP DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM KDI BAXTER HEALTHCARE - CLEVELAND GD892380

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR HOMECHOICE