MAUDE Adverse Event Report: ERIKA DE REYNOSA, S.A. DE C.V. LIBERTY CYCLER SET, SINGLE PATIENT CONN; SYSTEM, PERITONEAL, AUTOMATIC DELIVERY

Catalog Number	050-87215A
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Peritonitis (2252)
Date of Event	06/21/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Clinical investigation: there is a temporal relationship between peritoneal dialysis utilizing the liberty select cycler with liberty cycler set and the patient event of peritonitis.However, there is no documentation in the complaint file to show a causal relationship between the adverse event and the use of the liberty select cycler and cycler set.Additionally, there is no allegation or evidence of a device malfunction or deficiency, or cycler set defect reported for this event.Although there was no cause of the peritonitis determined, the culture result of pseudomonas aeruginosa suggests a breach in aseptic technique.This organism is commonly found in the environment, particularly in freshwater, hot tubs, jacuzzis, and swimming pools.Based on the available information and no allegation of a malfunction, deficiency, or defect the liberty select cycler and cycler set can be excluded as the cause of the patient¿s reported peritonitis event.The plant investigation is in process.A supplemental mdr will be submitted upon completion of this activity.
Event or Problem Description
A peritoneal dialysis (pd) patient contact reported to fresenius customer support that a patient is in the hospital and they think he may have an infection in the catheter tube.Additional information was obtained through follow-up with the patient¿s peritoneal dialysis registered nurse (pdrn).The patient was admitted to the hospital on (b)(6) 2025.No symptoms were reported.The patient had pd cultures obtained.The patient was diagnosed with peritonitis.The patient was initiated on antibiotics with intraperitoneal (ip) vancomycin and ceftazidime (dose, frequency, and duration unknown).The cultures were positive for growth with pseudomonas aeruginosa.The patient¿s pd catheter was pulled (date unknown) and the patient was transitioned to hemodialysis (hd).It is unknown what antibiotic therapy the patient is completing while on hd.No discharge date was noted in the patient¿s records.The cause of the peritonitis was unknown.
Additional Manufacturer Narrative
Plant investigation: the sample was not returned to the manufacturer and the lot number was not provided.A manufacturing review was performed on the products shipped to the patient for the three (3) month time frame which immediately preceded the event occurrence date.This review included the lot numbers for all fresenius liberty cycler sets shipped to this account within the selected time frame.The entire set of lots have been sold and distributed.There were no non-conformances or abnormalities identified during the manufacturing process which could be associated with the reported event.An investigation of the device history records (dhr) was conducted and confirmed that the results of the in-progress and final quality control (qc) testing met all requirements.The product lots involved met all specifications for release.A review of the dhr did not reveal a probable cause for the customer complaint.As a physical evaluation could not be performed, a definitive conclusion regarding the reported incident could not be reached and a cause could not be confirmed.
Event or Problem Description
A peritoneal dialysis (pd) patient contact reported to fresenius customer support that a patient is in the hospital and they think he may have an infection in the catheter tube.Additional information was obtained through follow-up with the patient¿s peritoneal dialysis registered nurse (pdrn).The patient was admitted to the hospital on (b)(6) 2025.No symptoms were reported.The patient had pd cultures obtained.The patient was diagnosed with peritonitis.The patient was initiated on antibiotics with intraperitoneal (ip) vancomycin and ceftazidime (dose, frequency, and duration unknown).The cultures were positive for growth with pseudomonas aeruginosa.The patient¿s pd catheter was pulled (date unknown) and the patient was transitioned to hemodialysis (hd).It is unknown what antibiotic therapy the patient is completing while on hd.No discharge date was noted in the patient¿s records.The cause of the peritonitis was unknown.

• Brand Name: LIBERTY CYCLER SET, SINGLE PATIENT CONN
• Common Device Name: SYSTEM, PERITONEAL, AUTOMATIC DELIVERY
• Manufacturer (Section D): ERIKA DE REYNOSA, S.A. DE C.V.; mike allen #1331; parque industrial reynosa; reynosa 88780 ; MX 88780
• Manufacturer (Section G): ERIKA DE REYNOSA, S.A. DE C.V.; director, quality systems; 900 w zaragosa drive suite d; pharr TX 78577
• Manufacturer Contact: jessica trujillo ; 920 winter st; waltham, MA 02451 ; 6174175172
• MDR Report Key: 22671281
• Report Number: 0008030665-2025-01719
• Device Sequence Number: 11718605
• Product Code: FKX
• UDI-Device Identifier: 00840861102709
• UDI-Public: 00840861102709
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K173718
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Consumer,Health Professional,User Facility,Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 10/17/2025

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: Lay User/Patient
• Device Catalogue Number: 050-87215A
• Was Device Available for Evaluation?: No
• Device Age: MO
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/23/2025
• Supplement Date Received by Manufacturer: 10/15/2025
• Initial Report FDA Received Date: 07/30/2025
• Supplement Report FDA Received Date: 10/17/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• 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: DELFLEX PD FLUID.; DELFLEX PD FLUID.; LIBERTY SELECT CYCLER.; LIBERTY SELECT CYCLER.
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 63 YR
• Patient Sex: Male