inforMED
OtherFII

PHOENIX

Received Apr 25, 2008 · Event occurred Mar 21, 2008

Report 2087532-2008-00043 · MDR key 1039590

Device

Generic name

Hemodialysis Equipment

Manufacturer

Gambro Dasco

Model number

PHOENIX

Catalog number

6023006700

Lot number

NA

Product problems

  • Normal
  • Unknown (for use when the device problem is not known)

Patient

83 YR

  • Cardiac Arrest
  • Death

Narrative

Description of Event or Problem

IN 2008, GAMBRO RECEIVED A REPORT OF A PT WHO WENT INTO CARDIAC ARREST AND DIED WHILE DIALYZING ON A PHOENIX MACHINE, SOFTWARE VERSION 3.34. EMERGENCY MEDICAL SERVICES WAS CALLED AND THE PT WAS TRANSFERRED TO THE HOSPITAL WHERE HE WAS PRONOUNCED DEAD. BOTH FACILITY'S BIOMEDICAL TECHNICIAN AND A GAMBRO TECHNICIAN INSPECTED THE MACHINE. ALL TESTS WERE WITHIN MFR'S SPECIFICATIONS.