MAUDE Adverse Event Report: FRESENIUS MEDICAL CAR NORTH AMERICA GRANUFLO

Device Problem Insufficient Information (3190)

Patient Problem Death (1802)

Event Date 11/04/2005

Event Type  Death  

Event Description

The plaintiff's attorney alleged that the decedent experienced a cardiovascular event on or about (b)(6) 2005 and subsequently expired after the use of the product.

Manufacturer Narrative

This is one event (death) for the same pt involving two separate products.

• Brand Name: GRANUFLO
• Manufacturer (Section D): FRESENIUS MEDICAL CAR NORTH AMERICA; waltham MA
• Manufacturer Contact: corie vazquez ; 920 winter street; waltham, MA 02451 ; 7816999071
• MDR Report Key: 4454199
• MDR Text Key: 5429313
• Report Number: 1225714-2015-00196
• Device Sequence Number: 1
• Product Code: KPO
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K030497
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Consumer
• Reporter Occupation: Attorney
• Type of Report: Initial
• Report Date: 01/07/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/23/2015
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No

Device Operator

• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 01/07/2015
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unkown

Patient Treatment Data

Date Received: 01/23/2015 Patient Sequence Number: 1