MAUDE Adverse Event Report: BAXTER HEALTHCARE CORPORATION POLYFLUX 140H DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM

Catalog Number 112465

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Abdominal Pain (1685); Low Blood Pressure/ Hypotension (1914); Diaphoresis (2452)

Event Date 05/10/2021

Event Type  Injury  

Manufacturer Narrative

Initial reporter phone no. (b)(6). Should additional relevant information become available, a supplemental report will be submitted.

Event Description

It was reported that after starting treatment with a polyflux 140h, the patient experienced abdominal pain, sweating and low blood pressure. Treatment was interrupted and the patient was treated with intravenous injection of 50% gs 40ml and ecg monitoring. After 30 minutes of observation, the patient's discomfort did not improve and the patient was given an injection of 50% gs 40ml and hemofiltration therapy was stopped and the patient was being monitored. It was reported that the patient's symptoms did not improve and the patient was hospitalized. No additional information is available.

• Brand Name: POLYFLUX 140H
• Type of Device: DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM
• Manufacturer (Section D): BAXTER HEALTHCARE CORPORATION; deerfield IL
• Manufacturer (Section G): BAXTER HEALTHCARE - HECHINGEN BADEN DIALYZER; holger - crafoord - strasse 26; hechingen D-723 79; GM D-72379
• Manufacturer Contact: 25212 w. illinois route 120; round lake, IL ; 2242702068
• MDR Report Key: 12372985
• MDR Text Key: 268327743
• Report Number: 9611369-2021-00223
• Device Sequence Number: 1
• Product Code: KDI
• UDI-Device Identifier: 07332414102753
• UDI-Public: (01)07332414102753
• Combination Product (y/n): Y
• Reporter Country Code: CH
• PMA/PMN Number: NA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig

Reporter Occupation

• Type of Report: Initial,Followup
• Report Date: 09/27/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/26/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No

Device Operator

• Device Catalogue Number: 112465
• Device Lot Number: 0-5812-H-01
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes

Was the Report Sent to FDA?

• Event Location: No Information
• Date Manufacturer Received: 09/07/2021
• Was Device Evaluated by Manufacturer?: No Answer Provided
• Date Device Manufactured: 07/03/2020
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial

Patient Treatment Data

Date Received: 08/26/2021 Patient Sequence Number: 1