BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MINI-CAP

    MDR report key: 3093968 · Received May 6, 2013

    Report

    Report Number
    1416980-2013-11400
    Event Type
    Injury
    Date Received
    May 6, 2013
    Date of Event
    March 19, 2013
    Report Date
    April 10, 2013
    Manufacturer
    BAXTER HEALTHCARE CORPORATION
    Product Code
    KDI
    PMA / PMN Number
    K895631
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ID, US
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). A REVIEW OF ALL BATCH RECORD DOCUMENTS FOR POTENTIALLY ASSOCIATED LOT NUMBER: GD893735 WITH NO ISSUES NOTED DURING THE MANUFACTURING PROCESS. THERE WERE NO DEVIATIONS FROM STANDARD PROCEDURE AND NO EXCEPTIONS RELATED TO THE REPORTED CONDITION WERE NOTED. THE CAUSE OF PERITONITIS WAS UNKNOWN. ON AN UNREPORTED DATE, THE PATIENT WAS RETRAINED ON A PROPER ASEPTIC TECHNIQUE. THE PATIENT RECOVERED FROM PERITONITIS.

    Additional Manufacturer Narrative · 1

    (B)(4). SHOULD ADDITIONAL INFORMATION BECOME AVAILABLE, A FOLLOW-UP REPORT WILL BE SUBMITTED. SAME PATIENT AS (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT EXPERIENCED PERITONITIS COINCIDENT WITH PERITONEAL DIALYSIS (PD) THERAPY. THE PATIENT HAD SYMPTOMS OF ABDOMINAL PAIN AND CLOUDY EFFLUENT. THE PATIENT WAS TREATED WITH ANCEF 1500 MILLIGRAMS INTRAPERITONEAL (IP) DAILY FOR 3 DAYS AND GENTAMYCIN 40 MILLIGRAM IP DAILY. AFTER CULTURES RESULTS WERE NEGATIVE, ANCEF WAS STARTED AS 1 GRAM DAILY IP FOR 5 DAYS. THE PATIENT IS CONSIDERED TO BE RECOVERED FROM THIS EVENT AND THE CAUSE OF PERITONITIS IS UNKNOWN. PD THERAPY WAS ONGOING DURING THE EVENT OF PERITONITIS. THIS IS REPORT 2OF 4.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    196150 MINI-CAP DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM KDI BAXTER HEALTHCARE CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Required Intervention AMBUFLEX, EXTRANEAL