MAUDE MDR 3844614

MDR report key
3844614
Report number
3005345832-2014-00002
Event key
0
Event type
3
Date received
2014-05-28
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
100
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
DONNA SOWERS
Address
9300 GERMANTOWN ROAD GERMANTOWN MD 20874 US
Phone
240-240-2406
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1AMNISURERAPID FETAL MEMBRANE RUPTURE TESTAMNISURE INTERNATIONAL LLCNQMFMRT-1FMRT-1-25-USA2021R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-05-2801. D

Event Narratives#

D

Patient 1

AN UNEXPECTED AMNISURE NEGATIVE RESULT WAS RECEIVED FOR PATIENT ON (B)(6) 2013, AT 2AM. THE SAMPLE WAS COLLECTED AT THE BEDSIDE BY A NURSE AND SENT TO THE LAB FOR TESTING. THE TEST WAS PERFORMED BY A LAB TECHNICIAN. THE SAMPLE CONTAINED MECONIUM. IT WAS ALSO STATED THAT THE PATIENT FIRST REPORTED SIGNS/SYMPTOMS OF RUPTURE GREATER THAN 12 HOURS AND UP TO 3 DAYS PRIOR TO ADMISSION AND TESTING. AN AFI WAS ALSO RUN WITH A RESULT OF 9. THE PATIENT WENT INTO LABOR AND DELIVERY WHICH RESULTED IN FETAL DEATH.

N

Patient 1

THE COMPANY HAS EVALUATED THIS EVENT AND HAS DETERMINED THAT THE RESULT OBTAINED FROM THE DEVICE DID NOT CONTRIBUTE OR CAUSE THE DEATH OF THE FETUS. HOWEVER, THE COMPANY HAS DECIDED TO SUBMIT THIS MDR FOR INFORMATIONAL PURPOSES IN AN ABUNDANCE OF CAUTION AND TO ENSURE FULL COMPLIANCE WITH 21 CFR PART 803. THE COMPANY WILL SUPPLEMENT THIS MDR WITH ADDITIONAL INFORMATION, AS NECESSARY. BASED ON THE INFORMATION PROVIDED, IT IS CLEAR THAT THE TEST WAS NOT PERFORMED ACCORDING TO THE PRODUCT INSTRUCTIONS FOR USE. THE HEALTHCARE FACILITY REPORTED AN UNEXPECTED NEGATIVE RESULT ALTHOUGH MECONIUM AS PRESENT IN THE PATIENT SAMPLE. THE PERFORMANCE OF THE AMNISURE TEST HAS NOT BEEN ESTABLISHED IN THE PRESENCE OF MECONIUM AS STATED IN THE PRODUCT INFORMATION FOR USE. ADDITIONALLY, THE PATIENT COMPLAINED OF SYMPTOMS OF ROM THAT BEGAN GREATER THAN 12 HOURS AND UP TO 3 DAYS BEFORE THE TEST WAS PERFORMED. THE AMNISURE PRODUCT INSTRUCTIONS FOR USE STATES THAT A FALSE NEGATIVE MAY OCCUR WHEN A SAMPLE IS TAKEN 12 HOURS OR LATER AFTER A RUPTURE DUE TO OBSTRUCTIONS OF THE RUPTURE BY THE FETUS OR RESEALING OF THE AMNIOTIC SAC. IN GENERAL, THE PRODUCT INSTRUCTION FOR USE ADVISES PHYSICIANS TO EVALUATE ALL RESULTS IN CONJUNCTION WITH ADDITIONAL CLINICAL INFORMATION.