inforMED
MalfunctionGKT

APHERESIS KIT

Received Apr 16, 2021 · Event occurred Apr 14, 2021

Report MW5100829 · MDR key 11684932

Device

Generic name

Separator, Automated, Blood Cell, Diagnostic

Manufacturer

Terumo Bct, Inc.

Lot number

4359801

Product problems

  • Coagulation in Device or Device Ingredient
  • No Flow

Patient

51 YR

  • No Clinical Signs, Symptoms or Conditions
  • No Clinical Signs, Symptoms or Conditions

Narrative

Description of Event or Problem

PATIENT FOR SECOND DAY OF AUTOLOGOUS STEM CELL COLLECTION (B)(6) 2021. DURING PROCEDURE, CLOT NOTED IN COLLECTION BAG. UPON OBSERVATION, NO ACD-A WAS DRAINING FROM THE BAG. MD INFORMED AND ORDERED ADDITIONAL ACD-A TO BE ADDED TO THE PRODUCT. STEM CELL PROCESSING FACILITY NOTIFIED OF CLOTTING ISSUE PRIOR TO SENDING PRODUCT TO THE LAB. OF NOTE, THE RN VISUALIZED THE ACD-A WAS DRIPPING WHEN IT WAS HUNG, AND NO ALARMS WERE MADE BY THE MACHINE. KIT LOT # 2102113130, EXP 2/1/2023; ACD-A LOT # 4359801, EXP 8/22/2021. FDA SAFETY REPORT ID# (B)(4).