MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06 report with the FDA on 2015-04-24 for NEG BREAKPOINT COMBO 34 N/A B1017-404 manufactured by Beckman Coulter.
[5662420]
It was reported that (b)(6) survey isolate was identified as leminorella species. The specimen source was stool and the isolate was grown on blood agar plate (bap) and macconkey (mac) agar plate. The isolate was tested three times on separate dates using an overnight conventional gram negative nbc34 panel. Each panel test yielded biotype 41000002, leminorella sp. 93. 14% probability. The correct id of the isolate was shigella boydii per 2015 cap d-a bacteriology participant summary report. There was no patient involved as this was a proficiency survey.
Patient Sequence No: 1, Text Type: D, B5
[13228677]
The manufacturer participated in the same proficiency survey using (b)(6) survey isolate. When tested on conventional overnight panels and read on the wa instrument, an id of leminorella sp. 93. 14% was attained. When the same panel was read on the autoscan-4 (as-4) instrument, an id of shigella sp. 99. 30% was attained. The difference between the two reads was the cf8 (cephalothin 8? G/ml) well; the cf8 well was negative on the wa and positive on the as-4. It was noted that the cf8 well was a weak positive when visually verified. The results from the cf8 panel along with the panel results from the other biochemicals/antimicrobics are used to generate the biotype number for the organism tested and the corresponding identification. An id of shigella was also attained on two additional tests using rapid negative panels. Also, the sample was tested on an analytical profile index (api) strip as a reference test method and a low probability id of shigella sp. Was attained. Please refer to medwatch report number 2919016-2015-00011 and 2919016-2015-00012 for reports of a similar event which occurred on 02/09/2015 and 02/20/2015 respectively. Beckman coulter internal identifier for this report is cf (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[30230860]
This supplemental mdr is being submitted to correct the typographical error on the last paragraph entered in the initial mdr report as follows: please refer to medwatch report number 2919016-2015-00011 and 2919016-2015-00012 for reports of a similar event which occurred on (b)(6) 2015 and (b)(6) 2015 respectively. (note: dates entered on the initial report were (b)(6) 2015 and (b)(6) 2015 respectively).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2919016-2015-00013 |
| MDR Report Key | 4727229 |
| Report Source | 05,06 |
| Date Received | 2015-04-24 |
| Date of Report | 2015-03-27 |
| Date of Event | 2015-02-20 |
| Date Mfgr Received | 2015-03-27 |
| Date Added to Maude | 2015-05-27 |
| 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 | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | NORMA RAHILL |
| Manufacturer Street | 1584 ENTERPRISE BLVD |
| Manufacturer City | WEST SACRAMENTO CA 95691 |
| Manufacturer Country | US |
| Manufacturer Postal | 95691 |
| Manufacturer Phone | 9163742139 |
| Manufacturer G1 | BECKMAN COULTER |
| Manufacturer Street | 2040 ENTERPRISE BLVD |
| Manufacturer City | WEST SACRAMENTO CA 95691 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 95691 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | NEG BREAKPOINT COMBO 34 |
| Generic Name | MICRO DILUTION PANEL |
| Product Code | LTT |
| Date Received | 2015-04-24 |
| Model Number | N/A |
| Catalog Number | B1017-404 |
| Lot Number | NOT PROVIDED |
| Operator | OTHER HEALTH CARE PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BECKMAN COULTER |
| Manufacturer Address | 2040 ENTERPRISE BLVD WEST SACRAMENTO CA 95691 US 95691 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2015-04-24 |