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Adverse Event Report

BAXTER HEALTHCARE PLASMACELL C DISPOSABLE SET, SPIKESMART PLASMACELL-C DISPOSABLE SET   back to search results
Model Number 4R2256
Event Date 04/03/2004
Event Type  Other   Patient Outcome  Required Intervention;
Event Description

In 2004, a donor called the plasma center to report that approx 5 hour after their donation in 2004, they developed itching on their arms, legs and buttocks. The donor stated that the itching has continued. Center presonnel instructed the donor to increase their fluid intake and to take benadryl (dose unk). Additional info after the event revealed that the donation which occurred in 2004 was unremarkable. The donor left the plasma center facility in good condition after their donation. Donor was contacted by the center later in 2004 at which time the donor indicated that the benadryl had relieved the itching over the last two hours. No other complaints from the donor were experssed at the time of the follow-up call. The donor followed up with their physician in 2004. At that time the physician diagnosed the donor with pruritis and presrcibed benadryl (dose unk) and zyrtec (dose unk) for itching. The plasma center has deferred this donor from further apheresis donations.

 
Manufacturer Narrative

A batch review was review was performed by baxter for lot a04a22024. Results of the batch review revealed that there were no manufacturing related issues seen during the manufacturing process for this batch lot number. All appropriate test results were found to be within specification requirements. Microbilogical test results were satisfctory. The sterilization dose applied was the appropriate amount according to the product specification. The complaint database was queried over a two-year interval for any reports of "hives" for this lot number and product code. No other reports of "hives" have been received by baxter for lot number a04a22024. A total of 3 reports of "hives" have been received by baxter for product code 4r2256 without any serious outcomes.

 
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Brand NamePLASMACELL C DISPOSABLE SET, SPIKESMART
Type of DevicePLASMACELL-C DISPOSABLE SET
Baseline Brand NamePLASMACELL-C DISPOSABLE SET SPIKESMART
Baseline Generic NamePLASMACELL-C DISPOSABLE SET
Baseline Catalogue Number4R2256
Baseline Device FamilyAUTOPHERESIS-C KITS
Baseline Device 510(K) Number
Baseline Device PMA NumberP850001
Baseline Shelf Life Information
Baseline Preamendment? No
Transitional? No
510(K) Exempt? No
Shelf Life(Months)24
Date First Marketed07/03/1986
Manufacturer (Section F)
BAXTER HEALTHCARE
haina
DOMINICAN REPUBLIC
Manufacturer (Section D)
BAXTER HEALTHCARE
haina
DOMINICAN REPUBLIC
Manufacturer (Section G)
BAXTER HEALTHCARE CORPORATION
*
haina
DOMINICAN REPUBLIC
Manufacturer Contact
debbie lahr - manager
rt 120 & wilson road
round lake , IL 60073
(847) 270 -4695
Device Event Key513146
MDR Report Key524021
Event Key497387
Report Number1420141-2004-00018
Device Sequence Number1
Product CodeGKT
Report Source Manufacturer
Source Type Health Professional,Company Representative
Reporter Occupation Other
Type of Report Initial
Report Date 04/07/2004
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received05/07/2004
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? No
Device Operator Health Professional
Device EXPIRATION Date01/31/2006
Device MODEL Number4R2256
Device Catalogue Number4R2256
Device LOT NumberA04A22024
Was Device Available For Evaluation? No
Is The Reporter A Health Professional? Yes
Was the Report Sent to FDA? No
Date Manufacturer Received04/07/2004
Was Device Evaluated By Manufacturer? Device Not Returned To Manufacturer
Date Device Manufactured01/01/2004
Is The Device Single Use? Yes
Is this a Reprocessed and Reused Single-Use Device? No
Is the Device an Implant? No
Is this an Explanted Device?
Type of Device Usage Initial

Patient TREATMENT DATA
Date Received: 05/07/2004 Patient Sequence Number: 1
#TreatmentTreatment Date
1 (1) 4B7867Q LOT C605337 SODIUM CITRATE 2004 01/01/2004
2 (2) 2B1323N LOT C602094 SALINE 2004. 01/01/2004
3 (3) 4R2441 LOT V03J27N1 NEEDLE 2004. 01/01/2004

Database last updated on December 31, 2008

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