MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,07 report with the FDA on 2011-11-28 for BECKMAN SYCHRON TRIGLYCERIDES REAGENT 445850 manufactured by Beckman Coulter, Inc..
[2310720]
Customer reported to beckman coulter, inc. (bec) that the cx triglyceride reagent cartridge had a leakage because one cap was missing. There was no report of erroneous results generated. There was no report of any adverse event or injury requiring medical intervention or patient treatment. Bec is filing this report because triglyceride reagent contains material of animal origin and should be considered potentially infectious.
Patient Sequence No: 1, Text Type: D, B5
[9492993]
(b)(4).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2050012-2011-08142 |
| MDR Report Key | 2349946 |
| Report Source | 01,07 |
| Date Received | 2011-11-28 |
| Date of Report | 2011-08-22 |
| Date of Event | 2011-08-22 |
| Date Mfgr Received | 2011-08-22 |
| Device Manufacturer Date | 2011-03-31 |
| Date Added to Maude | 2012-07-18 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | MS. DUNG NGUYEN |
| Manufacturer Street | 250 S. KRAEMER BLVD. |
| Manufacturer City | BREA CA 92821 |
| Manufacturer Country | US |
| Manufacturer Postal | 92821 |
| Manufacturer Phone | 7149613634 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BECKMAN SYCHRON TRIGLYCERIDES REAGENT |
| Generic Name | LIPASE HYDROLYSIS/GLYCEROL KINASE ENZYME, TRIGLYCERIDES |
| Product Code | CDT |
| Date Received | 2011-11-28 |
| Catalog Number | 445850 |
| Lot Number | M103158 |
| Device Expiration Date | 2012-09-30 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BECKMAN COULTER, INC. |
| Manufacturer Address | 250 S. KRAMER BLVD. BREA CA 92821 US 92821 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2011-11-28 |