MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,05 report with the FDA on 2004-10-12 for VITROS IMMUNODIAGNOSTIC PRODUCTS HBSAG CONFIRMATION KIT 8228595 manufactured by Ortho-clinical Diagnostics.
[344879]
The customer reported obtaining a false negative hbsag confirmatory result on a patient sample. A false negative hbsag confirmatory result may present a risk to public health. No results were reported and there was no report of patient harm as a result of this event.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9680658-2004-00262 |
| MDR Report Key | 579979 |
| Report Source | 01,05 |
| Date Received | 2004-10-12 |
| Date of Report | 2004-09-22 |
| Date of Event | 2004-09-22 |
| Date Mfgr Received | 2004-09-22 |
| Device Manufacturer Date | 2004-02-01 |
| Date Added to Maude | 2005-03-11 |
| 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 | 0 |
| Manufacturer Contact | THOMAS SMITH |
| Manufacturer Street | 100 INDIGO CREEK DRIVE |
| Manufacturer City | ROCHESTER NY 146261501 |
| Manufacturer Country | US |
| Manufacturer Postal | 146261501 |
| Manufacturer Phone | 5854533735 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VITROS IMMUNODIAGNOSTIC PRODUCTS HBSAG CONFIRMATION KIT |
| Generic Name | IN VITRO DIAGNOSTIC |
| Product Code | LDM |
| Date Received | 2004-10-12 |
| Model Number | NA |
| Catalog Number | 8228595 |
| Lot Number | 190 |
| ID Number | NA |
| Device Expiration Date | 2005-01-07 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 569827 |
| Manufacturer | ORTHO-CLINICAL DIAGNOSTICS |
| Manufacturer Address | 100 INDIGO CREEK DRIVE ROCHESTER NY 146265101 US |
| Baseline Brand Name | VITROS IMMUNODIAGNOSTIC PRODUCTS HBSAG CONFIRMATORY KIT |
| Baseline Generic Name | HBSAG CONFIRMATORY KIT ASSAY |
| Baseline Model No | NA |
| Baseline Catalog No | 8228595 |
| Baseline ID | NA |
| Baseline Device Family | VITROS IMMUNODIAGNOSTIC PRODUCTS HBSAG CONFIRMATORY KIT |
| Baseline Shelf Life Contained | Y |
| Baseline Shelf Life [Months] | 10 |
| Baseline PMA Flag | Y |
| Premarket Approval | P0000 |
| Baseline 510K PMN | N |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2004-10-12 |