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Adverse Event Report

DADE MICROSCAN, INC. MICROSCAN 3ML INOCULUM WATER   back to search results
Catalog Number B1015-2
Event Date 04/28/1999
Event Type  Malfunction   Patient Outcome  Other;
Event Description

Microscan employee reported 3ml tube of inoculum water broke during opening. Employee was attempting to unscrew the cap when the tube broke in two about a half inch from the bottom of the threads. No injury occurred.

 
Manufacturer Narrative

10. H. 6. Eval codes: method: other: visual examination and mechanical torque testing of retentions performed and device history records reviewed by contract mfr, remel inc. Raw material inspection records reviewed, dimensional and polariscope analysis performed by glass vendor. H. 6 eval codes: results: customer/returned product: one tube was found to have two elongated cracks. Retention samples: mechanical torque testing: average off-torque was within acceptable range. Dimensional analysis: all measurements were within specs. Polariscope analysis confirmed that tubes were properly annealed. Visual examination, device history record review and raw material inspection review were acceptable. H. 6 eval codes: conclusions: shipping/handling contributed to the event. Investigation revealed defective tubes may be the result of improper stacking and/or handling by freight carrier during shipping process. Interim corrective action implemented by contract mfr to label pallots "do not double stack. " investigation of shipping/handling rigors is ongoing by dade microscan inc. Eval summary: remel inc. , the contract mfr of this product, performed the following eval of the product; review of device history record and associated documents, review of mfg equipment and processes, review of incoming inspection records, visual and off-torque analysis of retention samples. Review of the original raw material quality records, dimensional, and polariscope analysis were performed by the glass vendor. There have been no changes in the mfg processes, equipment and packaging of the product deemed as contributory to the event. Eval of the retention samples and review of quality assurance documentation indicates the tubes met required specs. In january of 1999, the shipping carrier was changed to a frieght carrier (other than remel inc. ) to comply with routing guidelines provided by the spec developer, dade microscan inc. Defective tubes may be the result of improper stacking and/or handling during the shipping process. The addition of placards to each pallet of product stating "do not double stack" has been implemented to address this concern. Investigation of shipping/handling rigors is ongoing by dade microscan inc.

 
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Brand NameMICROSCAN 3ML INOCULUM WATER
Type of DeviceINOCULUM WATER
Baseline Brand NameINOCULUM WATER-3ML
Baseline Generic NameINOCULUM WATER
Baseline Catalogue NumberB1015-2
Baseline Device FamilyPANEL INOCULATING SUPPLIES
Baseline Device 510(K) Number
Baseline Device PMA Number
Baseline Shelf Life Information Yes
Baseline Preamendment? No
Transitional? No
510(K) Exempt? Yes
Shelf Life(Months)12
Date First Marketed07/16/1986
Manufacturer (Section F)
DADE MICROSCAN, INC.
2040 enterprise blvd.
west sacramento CA 95691
Manufacturer (Section D)
DADE MICROSCAN, INC.
2040 enterprise blvd.
west sacramento CA 95691
Manufacturer (Section G)
DADE BEHRING, INC.
2040 enterprise blvd.
west sacramento CA 95691
Manufacturer Contact
maureen griffin-mende
2040 enterprise blvd.
west sacramento , CA 95691
(916) 374 -3174
Device Event Key218791
MDR Report Key225623
Event Key211754
Report Number2919016-1999-00004
Device Sequence Number1
Product CodeJSO
Report Source Manufacturer
Source Type Other
Reporter Occupation Other
Type of Report Initial
Report Date 05/28/1999
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received05/28/1999
Is This An Adverse Event Report? No
Is This A Product Problem Report? Yes
Device Operator Other
Device EXPIRATION Date07/31/1999
Device Catalogue NumberB1015-2
Device LOT Number1307
Was Device Available For Evaluation? Yes
Is The Reporter A Health Professional? No
Was the Report Sent to FDA? No
Device Agena
Event Location Not Applicable
Date Manufacturer Received04/28/1999
Was Device Evaluated By Manufacturer? Yes
Date Device Manufactured01/01/1999
Is The Device Single Use? Yes
Is the Device an Implant? No
Is this an Explanted Device?
Type of Device Usage Initial

Database last updated on December 31, 2008

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