FDA Adverse Event Death Summary report: N

NATURALYTE

MDR report key: 4832862 · Received June 9, 2015

Report

Report Number
1225714-2015-03802
Event Type
Death
Date Received
June 9, 2015
Date of Event
February 5, 2010
Report Date
June 3, 2015
Manufacturer
FRESENIUS MEDICAL CARE NORTH AMERICA
Product Code
KPO
PMA / PMN Number
K981043
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
MA, US
Reporter Occupation
NOT APPLICABLE

Narratives

Additional Manufacturer Narrative · 1

THIS IS ONE OF TWO DEVICE REPORTS RELATED TO THIS EVENT. THE PRODUCT WAS NOT RETURNED AND LOT OR SERIAL NUMBER IS NOT AVAILABLE. THE PRODUCT IS MANUFACTURED TO MEET THE ASSOCIATION FOR THE ADVANCEMENT OF MEDICAL INSTRUMENTATION REQUIREMENTS USING VALIDATED PROCESSES, AND RELEASED BASED ON A DETERMINATION THAT THE FINISHED PRODUCT MEETS THOSE REQUIREMENTS. PRODUCT IS NOT RELEASED IF IT DOES NOT MEET REQUIREMENTS OR IS NONCONFORMING. COMPLAINT CANNOT BE CONFIRMED BASED ON THE CURRENT INFORMATION. A FOLLOW UP REPORT WILL BE SUBMITTED UPON RECEIPT OF ANY ADDITIONAL INFORMATION.

Description of Event or Problem · 1

THE PLAINTIFF'S ATTORNEY ALLEGED THAT THE PATIENT EXPERIENCED CARDIAC ARRHYTHMIA, ISCHEMIA AND SUBSEQUENTLY EXPIRED. THIS IS ALLEGED TO HAVE BEEN CAUSED BY EXPOSURE TO THE PRODUCT ADMINISTERED DURING DIALYSIS TREATMENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
372855 NATURALYTE KPO FRESENIUS MEDICAL CARE NORTH AMERICA

Patients

Seq Age Sex Outcome Treatment
1 Death| L