MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2007-07-12 for DRIED POS COMBO TYPE 21 B1017-201 manufactured by Dade Behring, Inc..
[634155]
Customer reported enterococcus isolate vancomycin (va) mic discrepancy. The dried pos combo type 21 panel gave sensitive results and an alternate screening test method resistant for the clinical isolate. Results were not reported to the physician. Pt treatment was not prescribed or altered, and there was no report of adverse health consequences associated with the discrepant result being obtained.
Patient Sequence No: 1, Text Type: D, B5
[7910469]
Routine monitoring of complaint history and performance trends to ensure performance is within claims. Requested additional information to determine if malfunction occurred. Product is within performance claims.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2919016-2007-00004 |
| MDR Report Key | 880286 |
| Report Source | 05 |
| Date Received | 2007-07-12 |
| Date of Report | 2007-07-09 |
| Date of Event | 2007-06-18 |
| Date Mfgr Received | 2007-06-18 |
| Device Manufacturer Date | 2006-11-01 |
| Date Added to Maude | 2008-01-16 |
| 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 | 0 |
| Event Location | 0 |
| Manufacturer Contact | RICH LAGUNA |
| Manufacturer Street | 2040 ENTERPRISE BLVD. |
| Manufacturer City | WEST SACRAMENTO CA 95691 |
| Manufacturer Country | US |
| Manufacturer Postal | 95691 |
| Manufacturer Phone | 9163743163 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | DRIED POS COMBO TYPE 21 |
| Generic Name | ANTIMICROBIC SUSCEPT. PANEL: GRAM POS |
| Product Code | LTT |
| Date Received | 2007-07-12 |
| Model Number | NA |
| Catalog Number | B1017-201 |
| Lot Number | NA |
| ID Number | NA |
| Device Expiration Date | 2008-04-23 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | NA |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | B |
| Device Sequence No | 1 |
| Device Event Key | 946782 |
| Manufacturer | DADE BEHRING, INC. |
| Manufacturer Address | 2040 ENTERPRISE BLVD. WEST SACRAMENTO CA 95691 US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2007-07-12 |