inforMED
InjuryFII

PHOENIX

Received Apr 15, 2008 · Event occurred Apr 14, 2008

Report 1029650 · MDR key 1029650

Device

Generic name

Dialysis Machine, Crrt

Model number

PHOENIX

Catalog number

*

Lot number

*

Product problems

  • Device Alarm System
  • Conductivity

Patient

16 YR

  • Seizures
  • Hospitalization required

Narrative

Description of Event or Problem

THIS PATIENT WAS RECEIVING DIALYSIS WHEN THE CONDUCTIVITY GOT OUT OF RANGE. THE MACHINE FAILED TO ALARM AND THE PATIENT HAD A SEIZURE RESULTING IN AN OVERNIGHT ADMISSION TO PICU.====================== MANUFACTURER RESPONSE FOR DIALYSIS MACHINE, CRRT, PHOENIX======================THEY ARE CONCERNED. I'M SURE THEY WILL COME TO OUR FACILITY AND LOOK OVER THE PROBLEMS WE ARE HAVING.