MAUDE Adverse Event Report: OGDEN MANUFACTURING PLANT OPTIFLUX 180NR DIALYZER FINISHED ASSY.; DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM

Catalog Number	0500318N
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Hypersensitivity/Allergic reaction (1907); Itching Sensation (1943)
Date of Event	01/01/2023
Type of Reportable Event	Serious Injury
Event or Problem Description
On (b)(6) 2023, fresenius became aware a patient with end stage renal disease (esrd) on hemodialysis (hd) utilizing a optiflux 180nre dialyzer for renal replacement therapy (rrt) reportedly experienced allergic reactions, which caused itching (pruritis).No additional information was provided during intake.Follow-up with the clinical manager (cm) revealed there were a patient experienced pruritus during hd therapy.Additional information (patient demographics, hd orders, medication records, hospital records) was requested via email, however no response has been received.Despite the lack of detailed follow-up, the cm reported the patient is now undergoing hd therapy utilizing a nipro cellentia dialyzer without further incident.
Additional Manufacturer Narrative
Plant investigation: the plant investigation is in process.A supplemental mdr will be submitted upon completion of this activity.
Additional Manufacturer Narrative
Correction.
Event or Problem Description
On 22/aug/2023, fresenius became aware a patient with end stage renal disease (esrd) on hemodialysis (hd) utilizing a optiflux 180nre dialyzer for renal replacement therapy (rrt) reportedly experienced allergic reactions, which caused itching (pruritis).No additional information was provided during intake.Follow-up with the clinical manager (cm) revealed there were a patient experienced pruritus during hd therapy.Additional information (patient demographics, hd orders, medication records, hospital records) was requested via email, however no response has been received.Despite the lack of detailed follow-up, the cm reported the patient is now undergoing hd therapy utilizing a nipro cellentia dialyzer without further incident.
Event or Problem Description
On 22/aug/2023, fresenius became aware a patient with end stage renal disease (esrd) on hemodialysis (hd) utilizing a optiflux 180nre dialyzer for renal replacement therapy (rrt) reportedly experienced allergic reactions, which caused itching (pruritis).No additional information was provided during intake.Follow-up with the clinical manager (cm) revealed there were a patient experienced pruritus during hd therapy.Additional information (patient demographics, hd orders, medication records, hospital records) was requested via email, however no response has been received.Despite the lack of detailed follow-up, the cm reported the patient is now undergoing hd therapy utilizing a nipro cellentia dialyzer without further incident.
Additional Manufacturer Narrative
Plant investigation: the reported complaint was not confirmed as the complaint device was not returned for manufacturer evaluation.A lot history review was performed.There were two other complaints reported against the lot.The complaints addressed a patient reaction and are mentioned above (no samples).A production records review was performed on the reported lot.An investigation of the device history records (dhr) was conducted by the manufacturer.There was no indication of product nonacceptance, deviation, non-conformance, rework, labeling or process control failure during the manufacturing process which could be associated with the reported event.The lot met all release criteria.A definitive conclusion regarding the complaint incident cannot be reached without physical examination of the actual device.Therefore, the complaint is not confirmed.
Additional Manufacturer Narrative
Additional information: h6 health effect - clinical code correction: b5.
Event or Problem Description
On 22/aug/2023, fresenius became aware a patient with end stage renal disease (esrd) on hemodialysis (hd) utilizing a optiflux 180nr dialyzer for renal replacement therapy (rrt) reportedly experienced allergic reactions, which caused itching (pruritis).No additional information was provided during intake.Follow-up with the clinical manager (cm) revealed there were a patient experienced pruritus during hd therapy.Additional information (patient demographics, hd orders, medication records, hospital records) was requested via email, however no response has been received.Despite the lack of detailed follow-up, the cm reported the patient is now undergoing hd therapy utilizing a nipro cellentia dialyzer without further incident.

• Brand Name: OPTIFLUX 180NR DIALYZER FINISHED ASSY.
• Common Device Name: DIALYZER, HIGH PERMEABILITY WITH OR WITHOUT SEALED DIALYSATE SYSTEM
• Manufacturer (Section D): OGDEN MANUFACTURING PLANT; director, site quality; 475 west 13th street; ogden UT 84404
• Manufacturer (Section G): OGDEN MANUFACTURING PLANT; director, site quality; 475 west 13th street; ogden UT 84404
• Manufacturer Contact: jessica trujillo ; 920 winter st; waltham, MA 02451 ; 6174175172
• MDR Report Key: 17650958
• Report Number: 0001713747-2023-00591
• Device Sequence Number: 6332039
• Product Code: KDI
• UDI-Device Identifier: 00840861100125
• UDI-Public: 00840861100125
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K002277
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 11/01/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Expiration Date: 02/28/2026
• Device Catalogue Number: 0500318N
• Device Lot Number: 23BU04024
• Was Device Available for Evaluation?: No
• Device Age: MO
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/22/2023
• Supplement Date Received by Manufacturer: 09/26/2023; 09/26/2023; 11/01/2023
• Initial Report FDA Received Date: 08/30/2023
• Supplement Report FDA Received Date: 09/26/2023; 09/26/2023; 11/01/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 02/27/2023
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: FRESENIUS BLOODLINES; FRESENIUS BLOODLINES; FRESENIUS BLOODLINES; FRESENIUS BLOODLINES; FRESENIUS HEMODIALYSIS MACHINE; FRESENIUS HEMODIALYSIS MACHINE; FRESENIUS HEMODIALYSIS MACHINE; FRESENIUS HEMODIALYSIS MACHINE
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown