MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-08-16 for 66040 GASTROCCULT TEST FOR GASTRIC OCCULT BLOOD AND PH 40 TEST SLIDES manufactured by Beckman Coulter, Inc..
| Report Number | 8901021 |
| MDR Report Key | 8901021 |
| Date Received | 2019-08-16 |
| Date of Report | 2019-06-17 |
| Date of Event | 2019-06-14 |
| Report Date | 2019-06-17 |
| Date Reported to FDA | 2019-06-17 |
| Date Reported to Mfgr | 2019-08-16 |
| Date Added to Maude | 2019-08-16 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | RISK MANAGER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 66040 GASTROCCULT TEST FOR GASTRIC OCCULT BLOOD AND PH 40 TEST SLIDES |
| Generic Name | REAGENT, OCCULT BLOOD |
| Product Code | KHE |
| Date Received | 2019-08-16 |
| Model Number | 66040 |
| Catalog Number | 66040 |
| Lot Number | 20581 |
| Device Availability | * |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BECKMAN COULTER, INC. |
| Manufacturer Address | 250 S KRAEMER BLVD BREA CA 92821 US 92821 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-08-16 |