MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,other report with the FDA on 2015-10-30 for BLOOD COLLECTION DEVICE MBC6000 manufactured by Carefusion.
[29950270]
No product will be returned per customer. The customer complaint could not be confirmed because the product was discarded and not returned for failure investigation. The root cause of this failure was not identified.
Patient Sequence No: 1, Text Type: N, H10
[29950271]
The customer reported multiple occurrences of the rubber sheath covering the needle would become lodged inside of the blood culture vial when obtaining samples using the blood collection device. No patient harm reported.
Patient Sequence No: 1, Text Type: D, B5
[45247317]
Correction on initial report.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 9616066-2015-01376 |
| MDR Report Key | 5191553 |
| Report Source | COMPANY REPRESENTATIVE,OTHER |
| Date Received | 2015-10-30 |
| Date of Report | 2015-10-16 |
| Date Mfgr Received | 2016-04-22 |
| Device Manufacturer Date | 2015-04-14 |
| Date Added to Maude | 2015-10-30 |
| 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 | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. SYLVIA VENTURA |
| Manufacturer Street | 10020 PACIFIC MESA BLVD |
| Manufacturer City | SAN DIEGO CA 921214386 |
| Manufacturer Country | US |
| Manufacturer Postal | 921214386 |
| Manufacturer Phone | 8586172000 |
| Manufacturer G1 | CAREFUSION |
| Manufacturer Street | 10020 PACIFIC MESA BLVD |
| Manufacturer City | SAN DIEGO CA 921214386 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 921214386 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BLOOD COLLECTION DEVICE |
| Generic Name | BLOOD COLLECTION |
| Product Code | KST |
| Date Received | 2015-10-30 |
| Model Number | MBC6000 |
| Catalog Number | MBC6000 |
| Lot Number | 301150414 |
| Device Expiration Date | 2018-04-01 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | CAREFUSION |
| Manufacturer Address | 10020 PACIFIC MESA BLVD SAN DIEGO CA 921214386 US 921214386 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2015-10-30 |