MAUDE Adverse Event Report: FRESENIUS MEDICAL CARE NORTH AMERICA, OGDEN MANUFACTURING OPTIFLUX 160NRE DIALYZER FINISHED ASSY.

Catalog Number 0500316E

Device Problems Crack (1135); Fluid/Blood Leak (1250)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 08/21/2014

Event Type  malfunction  

Event Description

A hemodialysis inpatient user facility reported that during treatment, a blood leak occurred.The leak was visually observed and the machine alarmed.There was a crack in the venous connection in the header.Estimated blood loss was 230cc's.The patient was administered prophylactic antibiotics.The patient had no adverse effects and did not require any medical intervention.Sample is not available; sample was discarded.

Manufacturer Narrative

The plant investigation has not yet been completed.A follow up report will be filed upon completion of the investigation.

• Brand Name: OPTIFLUX 160NRE DIALYZER FINISHED ASSY.
• Manufacturer (Section D): FRESENIUS MEDICAL CARE NORTH AMERICA, OGDEN MANUFACTURING; ogden UT
• Manufacturer (Section G): OGDEN MANUFACTURING PLANT; 475 west 13th st.; ogden UT 84404
• Manufacturer Contact: tanya taft, rn cnor ; 920 winter st.; waltham, MA 02451 ; 8006621237
• MDR Report Key: 4202641
• MDR Text Key: 19296269
• Report Number: 1713747-2014-00463
• Device Sequence Number: 1
• Product Code: FJI
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K002761
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility,Company Representative
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 08/27/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/18/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 06/01/2017
• Device Catalogue Number: 0500316E
• Device Lot Number: 14HU06004
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 08/27/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 06/01/2014
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Treatment: FRESENIUS 2008K MACHINE
• Patient Age: 80 YR