BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SET, ADMINISTRATION, FOR PERITONEAL DIALYSIS, DISPOSABLE

    MDR report key: 2895764 · Received January 3, 2013

    Report

    Report Number
    1416980-2013-00236
    Event Type
    Injury
    Date Received
    January 3, 2013
    Date of Event
    November 1, 2012
    Report Date
    December 12, 2012
    Manufacturer
    BAXTER HEALTHCARE
    Product Code
    KDJ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    PATIENT

    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 PATIENTS DISCARD SUPPLIES AFTER EACH THERAPY, THE SAMPLE WAS NOT REQUESTED. A 510K NUMBER WILL NOT BE PROVIDED IN THE MDR AS THE PRODUCT CODE AND LOT NUMBER ARE UNKNOWN. SINCE THE LOT NUMBER IS UNKNOWN, NO BATCH REVIEW WILL BE PERFORMED. BAXTER HAS CONDUCTED A TREND REVIEW AND FOUND THAT SIMILAR REPORTS HAVE BEEN RECEIVED FOR THE REPORTED PROBLEM. BAXTER WILL CONTINUE TO MONITOR SIMILAR REPORTS TO DETERMINE IF FURTHER ACTIONS ARE REQUIRED. THE PROBLEM WAS NOT CONFIRMED AND THE CAUSE OF THE PERITONITIS WAS UNDETERMINED. NO DEVICE MALFUNCTION OR USE ERROR WAS IDENTIFIED.

    Description of Event or Problem · 1

    THIS REPORT WAS RECEIVED FROM GLOBAL PHARMACOVIGILANCE (GPV) AND IS A SPONTANEOUS REPORT FROM A CONSUMER WITH SUPPLEMENTAL INFORMATION PROVIDED BY A NURSE IN THE USA OF PERITONITIS IN A PATIENT COINCIDENT WITH DIANEAL THERAPY FOR PERITONEAL DIALYSIS (PD). DIANEAL THERAPY WAS ONGOING. DURING A CALL WITH BAXTER CUSTOMER SERVICES, THE FOLLOWING WAS REPORTED. ON (B)(6) 2012, THE PATIENT EXPERIENCED PERITONITIS MANIFESTED BY A SUDDEN ONSET OF ABDOMINAL PAIN AND WAS HOSPITALIZED FOR THE EVENT. THE CAUSE OF PERITONITIS AND THE CAUSATIVE ORGANISM WERE UNKNOWN. DURING THE HOSPITALIZATION, THE PATIENT RECEIVED UNKNOWN IV ANTIBIOTIC THERAPY (DOSE AND FREQUENCY UNKNOWN) FOR PERITONITIS. ON AN UNREPORTED DATE PRIOR TO DISCHARGE, THE PATIENT RECEIVED A DOSE OF VANCOMYCIN (1 G, IP) FOR PERITONITIS. ON AN UNREPORTED DATE, THE PATIENT WAS DISCHARGED. THE VANCOMYCIN THERAPY (1 G, IP) WAS REPEATED IN THE PD CLINIC ON (B)(6) 2012, AND THEN DISCONTINUED. THE PATIENT RECOVERED FROM THIS PERITONITIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2596 SET, ADMINISTRATION, FOR PERITONEAL DIALYSIS, DISPOSABLE KDJ BAXTER HEALTHCARE

    Patients

    Seq Age Sex Outcome Treatment
    1 38 YR Hospitalization| R DIANEAL PD4 AMBUFLEX