MAUDE MDR 2678075

MDR report key
2678075
Report number
2050012-2012-01621
Event key
0
Event type
3
Date of event
2012-07-09
Date received
2012-08-01
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
MS. DUNG NGUYEN
Address
250 S. KRAEMER BLVD. BREA CA 92821 US
Phone
714-714-7149
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1SYNCHON CX3 DELTAANALYZER, CHEMISTRY, MICRO, FOR CLINICAL USEBECKMAN COULTER, INC.JJF467501N/AY Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12012-08-010

Event Narratives#

D

Patient 1

THE CUSTOMER REPORTED OBTAINING SUPPRESSED CALCIUM RESULTS AND SODIUM REFERENCE DRIFT RESULTS GENERATED ON THE SYNCHON CX3 DELTA CLINICAL SYSTEM. THE CUSTOMER RECALIBRATED THE INSTRUMENT AND RE-RUN QC WHICH WAS WITHIN RANGE. POST CALIBRATION, THE CUSTOMER NOTICED A TEASPOON OF CLEAR FLUID LEAKED OUT FROM CALCIUM ELECTRODE CHANNEL. PER CUSTOMER, NO ERRONEOUS PATIENT RESULTS WERE GENERATED. BECKMAN COULTER INC. CUSTOMER TECHNICAL SPECIALIST (CTS), REVIEWED MATERIAL SAFETY DATA SHEET (MSDS) AND CHEMICAL EXPOSURE PLAN IN THE LABORATORY AND ASSISTED THE CUSTOMER IN TROUBLESHOOTING THE EVENT. THE CTS DIRECTED THE CUSTOMER ON REPLACING CALCIUM ELECTRODE QUADRING. HOWEVER, THE ISSUE PERSISTED. CTS GENERATED SERVICE CALL. THE CUSTOMER WAS WEARING PERSONAL PROTECTIVE EQUIPMENT (PPE) CONSISTING OF A LAB COAT AND GLOVES. THE CUSTOMER DID NOT COME IN CONTACT WITH THE FLUID AND DID NOT SEEK MEDICAL ATTENTION. NO EXPOSURE (SPRAYED OR SPLASHED) TO MUCOUS MEMBRANES OR OPEN WOUNDS WERE REPORTED. NO DEATH, INJURY OR CHANGES TO PATIENT TREATMENT OR RESULTS ARE ASSOCIATED WITH THIS EVENT. ON (B)(4) 2012, A FIELD SERVICE ENGINEER (FSE) VISITED THE SITE. THE FSE REMOVED AND REPLACED THE FOLLOWING: CALCIUM ELECTRODE ASSEMBLY. POTASSIUM AND CHLORIDE ELECTRODE BODY. RETAINER NUT. SERVICE ACTIVITY PERFORMED WAS VERIFIED TO MEET THE SPECIFIED REQUIREMENT PER ESTABLISHED PROCEDURES. ROUTINE SERVICE CALL RESOLVED THE ISSUE. THE CAUSE OF THE EVENT WAS A HAIRLINE FRACTURE IN THE RETAINER NUT.

N

Patient 1

(B)(4).