NI 71515

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1998-05-13 for NI 71515 manufactured by Medi-source Inc..

Event Text Entries

[105134] This item doesn't meet the specs for facility's lab and is not equivalent to those in fedlog. Investigation findings: subject item was not procured by the depot sys but per the centralized sys. A review of the spec indicates the dimensions are 75 millimeters length and 25 millimeters width [with a + / -(plus/minus) tolerance of 0. 8 millimeters for each dimension]. The thickness range is 0. 8 to 1. 1 millimeters. A review of the federal logistics catalog found: overall thickness range 0. 8 millimeters minimum and 1. 1 millimeters maximum was correctly listed; the dimensions for overall length and overall width should be listed as: overall length 75. 0 millimeters (minimum 74. 2 millimeters and maxium 75. 8 millimeters), and overall width 25. 0 millimeters (minimum 24. 2 millimeters and maximum 25. 8 millimeters). Instead of listed as: overall length 75. 4 millimeters nominal, overall width 25. 0 millimeters nominal. Someone may have been provided the wrong item if the item rec'd was not in accordance within the dimensions as indicated in the spec. Facility is considering subject complaint an isolated incident. Facility has rec'd no other quality complaints on subject firm. The complaint has been added to facility's quality history data file. Facility will monitor subject firm and if similar complaints are rec'd facility will initiate an investigation. Action taken to correct existing deficiency: an informational copy of the complaint was forwarded to the firm. Action taken to preclude recurrence: the fda was provided an informational copy of the complaint. Disposition instructions: to be locally determined. (retain material until advised. Need for alert notification: not applicable.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report NumberMW4002289
MDR Report Key177935
Date Received1998-05-13
Date of Report1998-04-28
Date Added to Maude1998-07-21
Event Key0
Report Source CodeVoluntary report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional3
Initial Report to FDA0
Report to FDA0
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameNI
Generic NameSLIDE, MICROSCOPE
Product CodeKEW
Date Received1998-05-13
Model NumberNI
Catalog Number71515
Lot NumberNI
ID Number6640-00-074-4191
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Implant FlagN
Date RemovedA
Device Sequence No1
Device Event Key173021
ManufacturerMEDI-SOURCE INC.
Manufacturer Address50 GORDON DR. SYOSSET NY 11791 US


Patients

Patient NumberTreatmentOutcomeDate
10 1998-05-13

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