MAUDE MDR 7058841

MDR report key
7058841
Report number
1917413-2017-00355
Event key
0
Event type
3
Date of event
2016-02-21
Date received
2017-11-27
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
BDX BRETT WILKO
Address
9450 SOUTH STATE STREET SANDY UT 84070 US
Phone
801-801-8015
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1BD VACUTAINER? CPT GLASS MOLECULAR DIAGNOSTICS TUBECELL PREP TUBEBECTON, DICKINSON & CO.JCF3627535105880R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-11-2701. O

Event Narratives#

N

Patient 1

DATE OF EVENT: UNKNOWN. THE DATE RECEIVED BY MANUFACTURER HAS BEEN USED FOR THIS FIELD. MEDICAL DEVICE EXPIRATION DATE: UNKNOWN. RESULT: BD HAD NOT RECEIVED SAMPLES, BUT PHOTOS WERE PROVIDED BY THE CUSTOMER FACILITY FOR INVESTIGATION. THE PHOTOS WERE EVALUATED AND THE CUSTOMER'S INDICATED FAILURE MODE FOR BREAKAGE WITH THE INCIDENT LOT WAS OBSERVED. A REVIEW OF THE MANUFACTURING RECORDS WAS COMPLETED FOR THE INCIDENT LOT # 5105880 AND NO ISSUES WERE IDENTIFIED. CONCLUSION: WITHOUT A SAMPLE, AN ABSOLUTE ROOT CAUSE FOR THIS INCIDENT CANNOT BE DETERMINED AS BD WAS NOT ABLE TO DUPLICATE OR CONFIRM THE CUSTOMER?S INDICATED FAILURE MODE.

D

Patient 1

IT WAS REPORTED THAT 16X125 MM., 8.0 ML. BD VACUTAINER? CPT GLASS MOLECULAR DIAGNOSTICS TUBE. GREEN/RED CONVENTIONAL CLOSURE. SEE THRU LABEL. ADDITIVE: DENSITY GRADIENT POLYMER GEL AND SODIUM HEPARIN FOR MONONUCLEAR CELL PREPARATION, BROKE DURING CENTRIFUGATION. NO INJURY OR MEDICAL INTERVENTION.