MAUDE MDR 1904243

MDR report key
1904243
Report number
1823260-2010-06898
Event key
0
Event type
3
Date of event
2010-09-16
Date received
2010-11-22
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
NA ERIC KOLODZIEJ
Address
9115 HAGUE ROAD NA INDIANAPOLIS IN 46250 US
Phone
317-317-3175
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ROCHE ACETAMINOPHENCOLORIMETRY, ACETAMINOPHENROCHE DIAGNOSTICSLDPNA2076717432221110900R Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12010-11-220

Event Narratives#

D

Patient 1

THE CUSTOMER REPORTED FAILING AN API SURVEY FOR CALCIUM AND ACETAMINOPHEN WHEN THE TESTS WERE RUN ON THE COBAS C311 ANALYZER, SERIAL NUMBER (B)(4). OF THE RESULTS PROVIDED, FOUR OF THE ACETAMINOPHEN RESULTS WERE DISCREPANT. FOR SAMPLE 1 THE CUSTOMER REPORTED AN ACETAMINOPHEN OF 67.1 UG/ML TO THE SURVEY; THE EXPECTED RANGE WAS 77.2 - 95.5 UG/ML. THE TEST WAS REPEATED WITH AN ACETAMINOPHEN OF 65.1 UG/ML. AFTER REPLACEMENT WITH NEW REAGENT AND CALIBRATION OF THE ASSAY THE CUSTOMER OBTAINED VALUES OF 81.3 AND 81.8 UG/ML. FOR SAMPLE 2 THE CUSTOMER REPORTED AN ACETAMINOPHEN OF 23.7 UG/ML TO THE SURVEY; THE EXPECTED RANGE WAS 26.8 - 34.9 UG/ML. THE TEST WAS REPEATED WITH AN ACETAMINOPHEN OF 23.4 UG/ML. AFTER REPLACEMENT WITH NEW REAGENT AND CALIBRATION OF THE ASSAY THE CUSTOMER OBTAINED A VALUE OF 28.8 UG/ML. FOR SAMPLE 3 THE CUSTOMER REPORTED AN ACETAMINOPHEN OF 44.9 UG/ML TO THE SURVEY; THE EXPECTED RANGE WAS 53.8 - 84.4 UG/ML. THE TEST WAS REPEATED WITH AN ACETAMINOPHEN OF 44.2 UG/ML. AFTER REPLACEMENT WITH NEW REAGENT AND CALIBRATION OF THE ASSAY THE CUSTOMER OBTAINED VALUES OF 55.0 AND 54.7 UG/ML. FOR SAMPLE 4 THE CUSTOMER REPORTED AN ACETAMINOPHEN OF 28.4 UG/ML TO THE SURVEY; THE EXPECTED RANGE WAS 33.6 - 42.4 UG/ML. THE TEST WAS REPEATED WITH AN ACETAMINOPHEN OF 28.9 UG/ML. AFTER REPLACEMENT WITH NEW REAGENT AND CALIBRATION OF THE ASSAY THE CUSTOMER OBTAINED A VALUE OF 35.0 UG/ML. THERE WERE NO PATIENTS INVOLVED IN THE EVENT, THEREFORE NONE WERE ADVERSELY AFFECTED. QUALITY CONTROLS FOR ACETAMINOPHEN WERE IN RANGE. THE CUSTOMER HAD LAST CALIBRATED THE ASSAY IN (B)(6). THE CUSTOMER STATED THAT ACETAMINOPHEN WAS NOT RUN VERY OFTEN AND, "THEY DID NOT HAVE VERY MANY QC POINTS TO USE FOR TRACKING OR TRENDING," AND THEY BELIEVED THAT LEAD TO RUNNING THE SURVEY ON, "LESS THAN IDEAL REAGENT." THE CUSTOMER DECLINED A SERVICE VISIT.

N

Patient 1

.