MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-04-26 for BD VACUTAINER? URINE ANALYSIS PRESERVATIVE TUBE 364992 manufactured by Becton, Dickinson & Co. (broken Bow).
[147365822]
Device evaluated by mfr: a device evaluation is anticipated, but has not yet begun. Upon completion of the investigation, a supplemental report will be filed.
Patient Sequence No: 1, Text Type: N, H10
[147365823]
It was reported that labeling error occurred with a bd vacutainer? Urine analysis preservative tube. The following information was provided by the initial reporter, "material no. 364992, batch no. 8249984. It was reported they received a tube with the wrong labeling. During a new product implementation of custom urine cup kit from aeromed #amm570 with three tubes, uap, c&s, 6ml non additive tube in the er the customer received a yellow top conical bottom tube labeled #364992 ua preservative tube. The tube either came from a ua straw kit #364991 or the amm570. The label does not have a yellow border at the top like our marble top 364992. "
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1917413-2019-01392 |
| MDR Report Key | 8557717 |
| Date Received | 2019-04-26 |
| Date of Report | 2019-05-20 |
| Date of Event | 2019-04-03 |
| Date Mfgr Received | 2019-04-04 |
| Device Manufacturer Date | 2018-09-06 |
| Date Added to Maude | 2019-04-26 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | BDX BRETT WILKO |
| Manufacturer Street | 9450 SOUTH STATE STREET |
| Manufacturer City | SANDY UT 84070 |
| Manufacturer Country | US |
| Manufacturer Postal | 84070 |
| Manufacturer Phone | 8015652341 |
| Manufacturer G1 | BECTON, DICKINSON & CO. (BROKEN BOW) |
| Manufacturer Street | 150 SOUTH 1ST AVENUE |
| Manufacturer City | BROKEN BOW NE 68822 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 68822 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | BD VACUTAINER? URINE ANALYSIS PRESERVATIVE TUBE |
| Generic Name | SPECIMEN TRANSPORT AND STORAGE CONTAINER |
| Product Code | KDT |
| Date Received | 2019-04-26 |
| Catalog Number | 364992 |
| Lot Number | 8249984 |
| Device Availability | * |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BECTON, DICKINSON & CO. (BROKEN BOW) |
| Manufacturer Address | 150 SOUTH 1ST AVENUE BROKEN BOW NE 68822 US 68822 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2019-04-26 |