MAUDE Adverse Event Report: IMMUCOR, INC. CAPTURE-R READY-SCREEN (4); REAGENT RED BLOOD CELLS

Catalog Number	0066812
Health Effect - Clinical Code	No Code Available (3191)
Date of Event	06/30/2016
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The immucor laboratory was unable to test a blood sample, because the blood sample was not available for further investigation.Retention product could not be evaluated because the product had already expired before the customer had originally contacted immucor.
Event or Problem Description
On 15jul2016, an (b)(6) customer site reported an unexpected negative antibody screen when using capture-r ready-screen (4) on a galileo neo instrument, when tested on (b)(6) 2016.

• Brand Name: CAPTURE-R READY-SCREEN (4)
• Common Device Name: REAGENT RED BLOOD CELLS
• Manufacturer (Section D): IMMUCOR, INC.; 3130 gateway drive; norcross GA 30091 5625
• MDR Report Key: 5851297
• Report Number: 1034569-2016-00194
• Device Sequence Number: 19131716
• Product Code: KSZ
• UDI-Device Identifier: 10888234001447
• UDI-Public: 10888234001447
• Combination Product (Y/N): N
• Initial Reporter Country: IT
• PMA/510(K) Number: 102707/0.0
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: foreign,health professional,u
• Initial Reporter Occupation: Medical Technologist
• Type of Report: Initial
• Report Date (Section B): 08/05/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Medical Technologist
• Device Expiration Date: 07/12/2016
• Device Catalogue Number: 0066812
• Device Lot Number: K374
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/15/2016
• Initial Report FDA Received Date: 08/05/2016
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1