MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,05,06 report with the FDA on 2012-01-13 for CX TRIGLYCERIDE REAGENT 445850 manufactured by Beckman Coulter, Inc..
[20218658]
On (b)(6) 2011, customer reported that they received a broken bottle of triglyceride reagent the day before. Customer stated that the bottle was leaking from a crack in the cartridge. No injury was reported. It was decided that an mdr should be filed because this reagent contain human origin material, and upon recur, it could be potentially infectious.
Patient Sequence No: 1, Text Type: D, B5
[20580299]
Beckman coulter identifier for this report is (b)(4).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2050012-2012-00074 |
| MDR Report Key | 2416241 |
| Report Source | 01,05,06 |
| Date Received | 2012-01-13 |
| Date of Report | 2011-12-16 |
| Date of Event | 2011-12-15 |
| Date Mfgr Received | 2011-12-16 |
| Date Added to Maude | 2012-08-02 |
| 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 SOUTH KRAEMER BOULEVARD |
| Manufacturer City | BREA CA 92821 |
| Manufacturer Country | US |
| Manufacturer Postal | 92821 |
| Manufacturer Phone | 7149614941 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CX TRIGLYCERIDE REAGENT |
| Generic Name | LIPASE HYDROLYSIS/GLYCEROL KINASE ENZYME, TRIGLYCERIDES |
| Product Code | CDT |
| Date Received | 2012-01-13 |
| Catalog Number | 445850 |
| Lot Number | Z105223 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BECKMAN COULTER, INC. |
| Manufacturer Address | 250 SOUTH KRAEMER BLVD. BREA CA 92821 US 92821 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2012-01-13 |