MAUDE MDR 3379762

MDR report key
3379762
Report number
1823260-2013-06045
Event key
0
Event type
3
Date of event
2013-09-13
Date received
2013-10-01
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
105
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
NA JENNIFER WOLFGRAM
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
1COBAS 6000 C501 MODULECLINICAL CHEMISTRY ANALYZERROCHE DIAGNOSTICSDKHNA05860636001NAR Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12013-10-010

Event Narratives#

D

Patient 1

THE CUSTOMER RECEIVED A QUESTIONABLE PHENYTOIN RESULT FOR ONE PATIENT SAMPLE. THE INITIAL RESULT OF 2.9 UG/ML WAS FROM AN ALIQUOT OF A "RED TOP TUBE" PROCESSED BY A CLIENT OF THE CUSTOMER. THIS RESULT WAS REPORTED OUTSIDE THE LABORATORY. THE DOCTOR QUESTIONED THE RESULT AND THE PATIENT WAS RETESTED AT THE HOSPITAL WITH A RESULT OF 21.9 UG/ML. AN SST SAMPLE THAT WAS DRAWN AT THE SAME TIME AS THE ORIGINAL "RED TOP TUBE" WAS TESTED AND THE RESULTS WERE 18.7 UG/ML AND 18.8 UG/ML. THE REPEAT RESULTS WERE BELIEVED TO BE CORRECT. THE CUSTOMER COULD NOT PROVIDE DETAILS CONCERNING IF THE PATIENT WAS ADVERSELY AFFECTED. THE PHENYTOIN REAGENT LOT NUMBER WAS 67251701 WITH AN EXPIRATION DATE OF 03/31/2014. THE FIELD SERVICE REPRESENTATIVE NOTED THE ORIGINAL POUR OFF TUBE WAS EMPTY AND DISCARDED SO IT COULD NOT BE CHECKED FOR ISSUES. HE CHECKED THE SYSTEM FUNCTIONS FOR RINSE, REAGENT AND SAMPLE DISPENSE WHICH WERE VERIFIED. HE CHECKED CALIBRATION AND QC AND RAN PRECISION WITH ALL RESULTS IN RANGE.

N

Patient 1

THE INVESTIGATION COULD NOT DETERMINE A SPECIFIC ROOT CAUSE DUE TO THE LIMITED INFORMATION PROVIDED BY THE CUSTOMER.

N

Patient 1

IT WAS UNKNOWN IF THE INITIAL REPORTER SENT REPORT TO THE FDA .