BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MINICAP

    MDR report key: 2931959 · Received January 28, 2013

    Report

    Report Number
    1416980-2013-02107
    Event Type
    Malfunction
    Date Received
    January 28, 2013
    Date of Event
    January 10, 2013
    Report Date
    January 10, 2013
    Manufacturer
    BAXTER HEALTHCARE - CLEVELAND
    Product Code
    KDI
    PMA / PMN Number
    K895631
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). THE SAMPLE IS REPORTED TO BE AVAILABLE FOR EVALUATION. IF THE SAMPLE IS RECEIVED OR ADDITIONAL RELEVANT INFORMATION BECOMES AVAILABLE, A FOLLOW-UP REPORT WILL BE SUBMITTED.

    Additional Manufacturer Narrative · 1

    (B)(4). A BATCH REVIEW WAS CONDUCTED AND THERE WERE NO DEVIATIONS FOUND RELATED TO THIS REPORTED CONDITION DURING THE MANUFACTURE OF THIS LOT. THE REPORTED PROBLEM OF PARTICULATE MATTER WAS CONFIRMED. THE LABORATORY ANALYSIS OF THE PARTICLES DETERMINED THAT THE ROOT CAUSE OF THE PROBLEM WAS THAT DURING PACKAGING OF THIS LOT, THE MINICAP OFF-LOAD STATION CRASHED, CAUSING MECHANICAL ISSUES. ALUMINUM PARTICLES FROM THE INCIDENT FELL ONTO THE UNCOVERED MINICAPS IN THIS INDEX. FOLLOWING THIS INCIDENT, CLEANING AND INSPECTION PROCEDURES WERE UPDATED AND IMPROVED. SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

    Description of Event or Problem · 1

    A CUSTOMER HAD CONTACTED BAXTER CORPORATE SURVEILLANCE REGARDING A MINI CAP POUCH WHICH HAD CONTAINED PARTICULATE MATTER (PM). THE PM WAS DESCRIBED AS BLACK 'DUST' ON THE CAP. THERE WAS NO PATIENT INVOLVEMENT, INJURY, MEDICAL INTERVENTION, OR ADVERSE EVENT ASSOCIATED WITH THIS REPORT. NO ADDITIONAL INFORMATION IS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    38161 MINICAP DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM KDI BAXTER HEALTHCARE - CLEVELAND

    Patients

    Seq Age Sex Outcome Treatment
    1