COBAS 6000 C501 MODULE 05036453001

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a * report with the FDA on 2010-06-16 for COBAS 6000 C501 MODULE 05036453001 manufactured by Roche Diagnostics.

Event Text Entries

[1621120] The user stated they failed a proficiency survey for c-reactive protein and performed a patient comparison as part of troubleshooting the issue. Of the data provided, the result for one neonatal sample was discrepant. The result from the c501 was 4. 28 mg/l and the result with another c- reactive protein application on another c501 analyzer (b) (4) was 0. 33 mg/dl (3. 3 mg/l). The user could not verify if the result of 4. 28 mg/l was reported. The user refused to provide further patient information. The reagent lot number of the c-reactive protein reagent was 62203601. The user refused a service visit for this issue.
Patient Sequence No: 1, Text Type: D, B5


[8625790] It was unknown if the initial reporter sent report to the fda.
Patient Sequence No: 1, Text Type: N, H10


[17530529] It was reported to boston scientific corporation that a flexima biliary stent system was used during a drainage procedure in the bile duct of a patient (the event date, patient age, sex, and weight are unknown). During the procedure, the physician felt strong resistance and the guide catheter broke as the guide catheter was retracted for stent deployment. The procedure was successfully completed with another flexima biliary stent system no reported patient complications. The patient was reported to be in good condition after the procedure.
Patient Sequence No: 1, Text Type: D, B5


[17596850] The investigation could not determine a clear root cause as adequate data such as diagnosis, medication, history, sample material and reaction kinetics were not provided. It was unknown if any diagnosis and/or treatment was made to the patient based on the false positive result. No adverse events were reported.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number1823260-2010-03566
MDR Report Key1724570
Report Source*
Date Received2010-06-16
Date of Report2010-11-11
Date of Event2010-06-02
Date Mfgr Received2010-06-03
Date Added to Maude2010-11-11
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location3
Manufacturer ContactERIC KOLODZIEJ
Manufacturer Street9115 HAGUE ROAD
Manufacturer CityINDIANAPOLIS IN 46250
Manufacturer CountryUS
Manufacturer Postal46250
Manufacturer Phone3175212834
Manufacturer G1HITACHI HIGH TECH CORP.
Manufacturer Street882 ICHIGE HITACHINAKA
Manufacturer CityIBARAKI 312-8504
Manufacturer Postal Code312-8504
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameCOBAS 6000 C501 MODULE
Generic NameCLINICAL CHEMISTRY ANALYZER
Product CodeDCN
Date Received2010-06-16
Catalog Number05036453001
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerROCHE DIAGNOSTICS
Manufacturer Address9115 HAGUE ROAD INDIANAPOLIS IN 46250 US 46250


Patients

Patient NumberTreatmentOutcomeDate
10 2010-06-16

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