MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 00,01,07 report with the FDA on 2014-11-13 for URISYS 1100 03617548001 manufactured by Roche Diagnostics.
[5047190]
Reporter stated that the urisys 1100 was "not working. " upon inspection, the reporter noted that the device's printer paper had jammed and appeared to be blackened. Additionally, reporter noted that the printer port emitted a "burning smell. " an image of the suspect device, provided to the manufacturer by the end-user, showed that the plastic housing around the printer port had warped. Reporter stated that the event occurred overnight and was not witnessed by any staff member. No adverse event was reported. The manufacturer requested the return of the suspect product for evaluation.
Patient Sequence No: 1, Text Type: D, B5
[12552598]
Although this device is not sold in the united states, it is like or similar to a u. S. Distributed product.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1823260-2014-08850 |
| MDR Report Key | 4247622 |
| Report Source | 00,01,07 |
| Date Received | 2014-11-13 |
| Date of Report | 2014-12-12 |
| Date of Event | 2014-10-17 |
| Date Mfgr Received | 2014-10-17 |
| Date Added to Maude | 2014-11-13 |
| 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 |
| Reporter Occupation | MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 3 |
| Manufacturer Contact | NA MICHAEL LESLIE |
| Manufacturer Street | 9115 HAGUE ROAD NA |
| Manufacturer City | INDIANAPOLIS IN 46250 |
| Manufacturer Country | US |
| Manufacturer Postal | 46250 |
| Manufacturer Phone | 3175214343 |
| Manufacturer G1 | ROCHE DIAGNOSTICS GMBH |
| Manufacturer Street | SANDHOFERSTRASSE 116 NA |
| Manufacturer City | MANNHEIM (BADEN-WURTTEMBERG) 68305 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 68305 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | URISYS 1100 |
| Generic Name | AUTOMATED URINE ANALYZER |
| Product Code | KHE |
| Date Received | 2014-11-13 |
| Returned To Mfg | 2014-11-05 |
| Model Number | NA |
| Catalog Number | 03617548001 |
| Lot Number | NA |
| ID Number | NA |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ROCHE DIAGNOSTICS |
| Manufacturer Address | 9115 HAGUE ROAD NA INDIANAPOLIS IN 46250 US 46250 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2014-11-13 |