PRISM HTLV-I/HTLV-II 6E50-68

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2009-11-05 for PRISM HTLV-I/HTLV-II 6E50-68 manufactured by Abbott Laboratories.

Event Text Entries

[1431770] The pt experienced a loss of therapeutic effect and no stimulation sensation after bending over to pick something where he felt a "pop". The pt also had a problem with the external recharger unit which was not charging the device. The charger unit was replaced. Additional information was requested.
Patient Sequence No: 1, Text Type: D, B5


[8702268] (b)(4). Evaluation - reactivity originating from the htlv-i viral lysate thirty of 79 prism htlv-i / htlv-ii reagent lots, list number 06e50-68, have exhibited initial reactive rates (irr) and/or repeat reactive rates (rrr) that exceed the package insert 95% confidence interval upper limit. Multiple customer complaints related to reactive rates from several sites representing various geographic areas for these lots have been received since (b)(4) 2008. Four risk evaluations were performed during the course of the investigation. There was no impact to product functionality or product performance. The package insert only contains the combined reactive rate performance data for the design validation lots, and did not reflect the performance of the 3 individual design validation lots. Although there was a correlation for repeat reactive rate with s/co of the donor population and positive calibrator counts; adjusting the assay cutoff value by selection of the positive calibrator dilution factor (df) did not significantly influence the reactive rate. The htlv-i components of the assay, which includes the htlv-i microparticle concentrate, htlv-i probe concentrate, and glycoprobe concentrate, were associated with the nonspecific reactivity for non-confirming reactive samples obtained from customers. However, no correlation between reactive rates and final concentration of these components in the reagent kit was identified. The common reagent of the htlv-i components is the htlv-i lysate. A change point related to a best practices improvement to the htlv-i lysate manufacturing correlated with reactive rate. However, non-confirming reactive samples exhibited an interaction with htlv-i assay components regardless of reagent lot. Some non-confirming reactive sample reactivity was reduced by pretreatment with heterophile blocking reagents and cysteine reductant, suggesting that the reactivity was a result of a sample-specific antibody interaction with components of the assay reagents. The probable cause of some reagent lots exhibiting irr and/or rrr that exceed the package insert 95% confidence interval upper limit is that these clinical results were obtained from the 3 clinical lots combined and does not accurately represent the individual clinical lot irr and rrr performance. A contributing factor for the higher than expected repeat reactive rates observed at multiple customer sites for the prism htlv-i/htlv-ii assay is a sample-specific antibody interaction with the microparticle and probe components of the assay reagents. The target of this reactivity originates from the htlv-i viral lysate.
Patient Sequence No: 1, Text Type: N, H10


[15559095] The account stated they are seeing an increase in reactive rates for prism htlv-i/htlv-ii where most of the samples do not confirm. The account stated the repeat reactive prism htlv-i/htlv-ii samples are tested with innolia htlv-i/ii score immunoblot for confirmation. The account uses serum samples for testing. No specific testing values or patient information was provided. No impact to patient management was reported.
Patient Sequence No: 1, Text Type: D, B5


[15927728] (b) (4) - evaluation - investigation in process, no method, results or conclusion code can be chosen at this time. This is an initial report. An investigation is in process. A final report will be submitted when the investigation is complete.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number1415939-2009-01150
MDR Report Key1521166
Report Source05
Date Received2009-11-05
Date of Report2009-09-16
Date Mfgr Received2010-08-17
Device Manufacturer Date2010-04-05
Date Added to Maude2010-09-13
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactNOEMI KONDOS RN, BSN
Manufacturer Street200 ABBOTT PARK ROAD DEPT. 09B9, AP50
Manufacturer CityABBOTT PARK IL 600643537
Manufacturer CountryUS
Manufacturer Postal600643537
Manufacturer Phone8479375120
Manufacturer G1ABBOTT LABORATORIES
Manufacturer Street100 ABBOTT PARK ROAD
Manufacturer CityABBOTT PARK IL 60064350
Manufacturer CountryUS
Manufacturer Postal Code60064 3500
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NamePRISM HTLV-I/HTLV-II
Generic NameFOR DETECTION OF HTLV-I/ HTLV-II ANTIBODIES IN HUMAN SERUM OR PLASMA
Product CodeMTP
Date Received2009-11-05
Catalog Number6E50-68
Lot Number74602M100
ID Number74601M100
Device Expiration Date2010-04-01
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerABBOTT LABORATORIES
Manufacturer Address100 ABBOTT PARK ROAD ABBOTT PARK IL 60064350 US 60064 3500


Patients

Patient NumberTreatmentOutcomeDate
10 2009-11-05

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