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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BAXTER HEALTHCARE CORPORATION PRISMAXPRISMAX SYSTEM; DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM
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BAXTER HEALTHCARE CORPORATION PRISMAXPRISMAX SYSTEM; DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM Back to Search Results
Model Number 955626
Device Problem Failure of Device to Self-Test (2937)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 09/28/2020
Event Type  malfunction  
Event Description
Upon setup of machine, machine exhibited arps self-test failure.Machine unusable; red tagged and reported to biomed.Manufacturer response for continuous renal replacement therapy machine, prismaflex system for critical care (per site reporter).Baxter sales rep discussed issue with icu equipment & supply coordinator.Baxter rep stated that faulty arps tubing noted to be source of problem but stated that baxter would not repair machines until device exhibited yet another failure.However, due to safety concerns regarding potential failure while running on patient, icu leadership pulled machines from service.Supply coordinator emailed service rep stating that hospital expects all machines to be proactively repaired prior to putting back in service; awaiting response from baxter.
 
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Brand Name
PRISMAXPRISMAX SYSTEM
Type of Device
DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM
Manufacturer (Section D)
BAXTER HEALTHCARE CORPORATION
one baxter parkway
deerfield IL 60015
MDR Report Key10991245
MDR Text Key220919758
Report Number10991245
Device Sequence Number1
Product Code KDI
Combination Product (y/n)N
Number of Events Reported1
Summary Report (Y/N)N
Report Source User Facility
Reporter Occupation Nurse
Type of Report Initial
Report Date 11/25/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received12/11/2020
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Model Number955626
Device Catalogue Number955626
Was Device Available for Evaluation? Yes
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA? Yes
Date Report Sent to FDA11/25/2020
Device Age1 MO
Event Location Hospital
Date Report to Manufacturer12/11/2020
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Unknown
Patient Sequence Number1
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