MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2015-11-12 for COC THC MOP AMP MAMP BZO BAR MTD MDMA OX DOA-1127-041-19-ONW02A manufactured by Alere San Diego, Inc..
[31019327]
Investigation conclusion: customer's observation was not replicated in-house with retention product. Retention products were tested with 29 samples of drug-free donor urine; all mtd, coc results were negative at read time. No false positive were obtained. Mfg batch record review did not uncover any abnormalities. Root cause could not be determined from the information provided. Based on the information available, there is no indication of a product deficiency. No corrective action is required at this time.
Patient Sequence No: 1, Text Type: N, H10
[31019328]
Distributor claiming their client was having false positive results for coc and mtd. No test lines developed in the test region for each drug, all control lines developed. Client unable to provide lab results but claimed they did confirmation testing and it was negative. No images or returns are available for investigation. No additional or patient information provided. No adverse patient sequela reported.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2027969-2015-00925 |
| MDR Report Key | 5220507 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2015-11-12 |
| Date of Report | 2015-10-15 |
| Date Mfgr Received | 2015-10-15 |
| Date Added to Maude | 2015-11-12 |
| 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 | YA-LING KING |
| Manufacturer Street | 9975 SUMMERS RIDGE ROAD |
| Manufacturer City | SAN DIEGO CA 92121 |
| Manufacturer Country | US |
| Manufacturer Postal | 92121 |
| Manufacturer Phone | 8588052084 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | COC THC MOP AMP MAMP BZO BAR MTD MDMA OX |
| Generic Name | DRUG OF ABUSE TEST |
| Product Code | DKZ |
| Date Received | 2015-11-12 |
| Model Number | DOA-1127-041-19-ONW02A |
| Lot Number | DOA5030217 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ALERE SAN DIEGO, INC. |
| Manufacturer Address | 9975 SUMMERS RIDGE ROAD SAN DIEGO CA 92121 US 92121 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2015-11-12 |