MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06 report with the FDA on 2011-03-07 for COBAS 6000 C501 MODULE 05036453001 manufactured by Roche Diagnostics.
[1717794]
The customer received questionable aspartate aminotransferase (ast), alanine aminotransferase (alt) and creatine kinase (ck) results for one patient. The customer provided results for two samples from the patient. The results from one sample were discrepant and reported outside the laboratory. The initial ast result was -5 u/l. This result was reported outside the laboratory. The sample was retested on this cobas 6000 c501 analyzer and generated a result of -5 u/l (accompanied by a data flag). The sample was diluted and retested on another cobas 6000 c501 analyzer (serial number (b)(4)) and generated a result of -1 u/l (accompanied by a data flag). The diluted sample was repeated again and generated an ast result of 6456 u/l. The customer did not know which analyzer this result was generated from. This result was reported outside the laboratory as the corrected result. The initial alt result was 197 u/l. This result was reported outside the laboratory. The sample was retested on this cobas 6000 c501 analyzer and generated a result of 425 u/l (accompanied by a data flag). The sample was diluted and retested again and generated a result of 4778 u/l (accompanied by a data flag). This result was reported outside the laboratory as the corrected result. The initial ck result was 43858 u/l. This result was reported and never corrected. The sample was retested on this cobas 6000 c501 analyzer and generated a result of 74 u/l (accompanied by a data flag). The sample was diluted and retested on the other cobas 6000 c501 analyzer (serial number (b)(4)) and generated a result of 208 u/l (accompanied by a data flag). There was no adverse affect to the patient from the discrepant results being reported. The ast reagent lot number was 63417801. The alt reagent lot number was 63590501. The ck reagent lot number was 63546001. The field service representative did not find the cause of the discrepancies. He ran performance tests which were within specification. The operator performed quality control and precision tests, all were acceptable.
Patient Sequence No: 1, Text Type: D, B5
[9030923]
Due to insufficient data provided for the investigation, the root cause of the discrepancies could not be determined. The customer confirmed that the patient was not adversely affected presently, the instrument is working as expected.
Patient Sequence No: 1, Text Type: N, H10
[9039275]
.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1823260-2011-01179 |
| MDR Report Key | 2009063 |
| Report Source | 05,06 |
| Date Received | 2011-03-07 |
| Date of Report | 2011-04-20 |
| Date of Event | 2011-02-10 |
| Date Mfgr Received | 2011-02-10 |
| Date Added to Maude | 2011-03-07 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 3 |
| Manufacturer Contact | NA RICHEAL CLINE |
| Manufacturer Street | 9115 HAGUE ROAD NA |
| Manufacturer City | INDIANAPOLIS IN 46250 |
| Manufacturer Country | US |
| Manufacturer Postal | 46250 |
| Manufacturer Phone | 3175213833 |
| Manufacturer G1 | HITACHI HIGH TECH CORP. |
| Manufacturer Street | 882 ICHIGE HITACHINAKA NA |
| Manufacturer City | IBARAKI 312-8504 |
| Manufacturer Postal Code | 312-8504 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | COBAS 6000 C501 MODULE |
| Generic Name | CLINICAL CHEMISTRY ANALYZER |
| Product Code | CIF |
| Date Received | 2011-03-07 |
| Model Number | NA |
| Catalog Number | 05036453001 |
| Lot Number | NA |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ROCHE DIAGNOSTICS |
| Manufacturer Address | 9115 HAGUE ROAD NA INDIANAPOLIS IN 46250 US 46250 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2011-03-07 |