inforMED
MalfunctionFIL

FRESENIUS DIALYSIS DELIVERY SYSTEM

Received Jan 11, 2002 · Event occurred Dec 19, 2001

Report 2937457-2002-00007 · MDR key 371748

Device

Generic name

Hemodialysis Machine

Model number

2008K

Catalog number

NA

Lot number

NA

Product problems

  • Insufficient Flow or Under Infusion
  • Other (for use when an appropriate device code cannot be identified)

Patient

UNKNOWN

  • Low Blood Pressure/ Hypotension
  • Other (for use when an appropriate patient code cannot be identified)
  • Weight Changes

Narrative

Description of Event or Problem

REPORTS OF ULTRAFILTRATION PROBLEMS THAT WERE OBSERVED OVER SEVERAL MONTHS WERE RECEIVED FROM THE MANUFACTURER'S AFFILIATE IN CANADA ON 12/14/2001 AND ON 01/03/2002. REPORTS SUGGEST EXCESS FLUID WAS REMOVED DURING HEMODIALYSIS TREATMENTS. INFORMATION PROVIDED WAS VERY LIMITED. THERE WAS NO REPORTED SERIOUS INJURY. THE PATIENT BECAME HYPOTENSIVE 27 MINUTES INTO THE TREATMENT. "BLACK BLOOD" WAS REPORTEDLY OBSERVED. THE PATIENT'S POST WEIGHT INDICATED A WEIGHT LOSS OF 1.7 KG. THE MACHINE SHOWED THAT 397 ML. WAS REMOVED. PRESSURE HOLDING TEST WAS NOT PERFORMED AND ON-LINE PRESSURE HOLDING TEST WAS NOT ACTIVATED.