BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SET, ADMINISTRATION, FOR PERITONEAL DIALYSIS, DISPOSABLE

    MDR report key: 3021164 · Received March 26, 2013

    Report

    Report Number
    1416980-2013-07239
    Event Type
    Injury
    Date Received
    March 26, 2013
    Date of Event
    March 5, 2013
    Report Date
    March 5, 2013
    Manufacturer
    BAXTER HEALTHCARE
    Product Code
    KDJ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    RP
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). THE PROBLEM WAS NOT CONFIRMED, AS THERE WAS NO SAMPLE FOR EVALUATION AND NO DEVICE MALFUNCTION OR USE ERROR WAS IDENTIFIED DURING THE REPORT. THE ROOT CAUSE COULD NOT BE DETERMINED. 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.

    Additional Manufacturer Narrative · 1

    (B)(4): FIVE DAYS LATER AFTER HOSPITAL ADMISSION, THE PATIENT WAS DISCHARGED. THE PATIENT RECOVERED FROM THE EVENT OF PERITONITIS.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A PATIENT EXPERIENCED PERITONITIS COINCIDENT WITH PERITONEAL DIALYSIS (PD) THERAPY. THE PATIENT WAS HOSPITALIZED FOR PERITONITIS MANIFESTED BY ABDOMINAL PAIN, CLOUDY PD EFFLUENT, AND FEVER. THE PATIENT WAS TREATED WITH VANCOMYCIN (DOSE, ROUTE AND FREQUENCY NOT REPORTED) FOR THE PERITONITIS. THE OUTCOME FOR THIS PERITONITIS EVENT WAS NOT REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    124559 SET, ADMINISTRATION, FOR PERITONEAL DIALYSIS, DISPOSABLE KDJ BAXTER HEALTHCARE

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Hospitalization| R TRENTAL, DIAMICRON, AND SIMVASTATIN| DIANEAL PD2 1.5% AND DIANEAL PD2 4.25%