CAPTURE-R READY INDICATOR RED CELLS 0006428

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,user faci report with the FDA on 2019-01-18 for CAPTURE-R READY INDICATOR RED CELLS 0006428 manufactured by Immucor, Inc..

Event Text Entries

[133939450] The full number for the product in question is (b)(4) (1/27/2003). Immucor technical support used a remote electronic connection method on 04jan2019 to assess the testing instrument in question. The instrument test well images in question were visually negative, the camera calibration was in range and the event log showed no relevant information. Because the product was already expired at the time of immucor being made aware of this situation, the immucor laboratory determined that retention testing had previously already been performed when the product was in-date, but not on an echo lumena instrument, but rather a galileo echo instrument, and at that time, under those circumstances, the retention product performed as expected. The internal immucor record tracking number for this record is (b)(4).
Patient Sequence No: 1, Text Type: N, H10


[133939451] On (b)(6) 2019, a customer site reported an unexpectedly negative antibody screen when using capture-r ready indicator red cells on an echo lumena instrument, when tested on (b)(6) 2018, which led to an event being categorized as a delayed hemolytic transfusion reaction.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1034569-2019-00029
MDR Report Key8261112
Report SourceHEALTH PROFESSIONAL,USER FACI
Date Received2019-01-18
Date of Report2019-01-18
Date of Event2018-12-17
Date Mfgr Received2019-01-04
Date Added to Maude2019-01-18
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMR HOWARD YOREK
Manufacturer Street3130 GATEWAY DRIVE
Manufacturer CityNORCROSS GA 300915625
Manufacturer CountryUS
Manufacturer Postal300915625
Manufacturer Phone7704412051
Manufacturer G1IMMUCOR, INC.
Manufacturer Street3130 GATEWAY DRIVE
Manufacturer CityNORCROSS GA 300915625
Manufacturer CountryUS
Manufacturer Postal Code300915625
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameCAPTURE-R READY INDICATOR RED CELLS
Generic NameANTIGLOBULIN COATED RED CELLS
Product CodeKSF
Date Received2019-01-18
Catalog Number0006428
Lot Number221216
Device Expiration Date2018-12-23
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerIMMUCOR, INC.
Manufacturer Address3130 GATEWAY DRIVE NORCROSS GA 300915625 US 300915625


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2019-01-18

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