• Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BAXTER HEALTHCARE - MOUNTAIN HOME AMIA AUTOMATED PD CYCLER SET; SYSTEM, PERITONEAL, AUTOMATIC DELIVERY

  • Print
  • Share
  • E-mail
-
Super Search Devices@FDA
510(k) | DeNovo | Registration & Listing | Adverse Events | Recalls | PMA | HDE | Classification | Standards
CFR Title 21 | Radiation-Emitting Products | X-Ray Assembler | Medsun Reports | CLIA | TPLC
 

BAXTER HEALTHCARE - MOUNTAIN HOME AMIA AUTOMATED PD CYCLER SET; SYSTEM, PERITONEAL, AUTOMATIC DELIVERY Back to Search Results
Catalog Number 5C5479
Device Problem Break (1069)
Patient Problem No Consequences Or Impact To Patient (2199)
Event Type  malfunction  
Manufacturer Narrative
The incidents occurred on a unreported date in (b)(6) 2018.The device has been received and the evaluation is in progress.Should additional relevant information become available, a supplemental report will be submitted.
 
Event Description
It was reported that sixteen (16) amia cassettes were damaged.The damage was further described as the sheeting was "pulled up" from the cassettes.This was noticed during set up of peritoneal dialysis therapy.There was no patient injury or medical intervention associated with this event.No additional information is available.
 
Manufacturer Narrative
Five (5) samples out of sixteen (16) were received for evaluation.A visual inspection was performed with naked eye with no issues noted.Functional testing including leak testing, clear passage testing and clamp function testing were performed with no issues noted.The reported condition was not verified on the returned samples.Eleven (11) devices were not received for evaluation; therefore, a device analysis could not be completed on those samples.A batch review was conducted and there were no deviations found related to this reported condition during the manufacture of this lot.Should additional relevant information become available, a supplemental report will be submitted.
 
Search Alerts/Recalls

  New Search  |  Submit an Adverse Event Report

Brand Name
AMIA AUTOMATED PD CYCLER SET
Type of Device
SYSTEM, PERITONEAL, AUTOMATIC DELIVERY
Manufacturer (Section D)
BAXTER HEALTHCARE - MOUNTAIN HOME
mountain home AR
Manufacturer (Section G)
BAXTER HEALTHCARE - MOUNTAIN HOME
1900 n highway 201
mountain home AR 72653
Manufacturer Contact
25212 w. illinois route 120
round lake, IL 60073
2242702068
MDR Report Key8026602
MDR Text Key125758555
Report Number1416980-2018-06993
Device Sequence Number1
Product Code FKX
UDI-Device Identifier00085412153186
UDI-Public(01)00085412153186
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K151525
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,consum
Reporter Occupation Other
Type of Report Initial,Followup
Report Date 11/08/2018
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Lay User/Patient
Device Expiration Date10/10/2020
Device Catalogue Number5C5479
Device Lot NumberH18D10050
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer09/20/2018
Is the Reporter a Health Professional? No
Initial Date Manufacturer Received 10/09/2018
Initial Date FDA Received10/31/2018
Supplement Dates Manufacturer Received11/02/2018
Supplement Dates FDA Received11/08/2018
Was Device Evaluated by Manufacturer? Yes
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage N
Patient Sequence Number1
-
-