MAUDE MDR 3869460

MDR report key
3869460
Report number
1823260-2014-04299
Event key
0
Event type
3
Date of event
2014-05-22
Date received
2014-06-12
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 MICHAEL LESLIE
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 E411 SYSTEMIMMUNOCHEMISTRY ANALYZERROCHE DIAGNOSTICSJLBNAASKUNAR Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-06-120

Event Narratives#

D

Patient 1

THE CUSTOMER RECEIVED QUESTIONABLE CK-MB - THE MB ISOENZYME OF CREATINE KINASE STAT AND TROPONIN I STAT RESULTS FOR ONE PATIENT. THE INITIAL CKMB RESULT WAS 300 NG/ML WITH A DATA FLAG. THE INITIAL TROPONIN I RESULT WAS 25.00 NG/ML WITH A DATA FLAG. THE REPEAT CKMB RESULT WHEN DILUTED 1:10 WAS 41.28 NG/ML WITH A DATA FLAG. THE REPEAT TROPONIN I RESULT WHEN DILUTED 1:10 WAS 23.21 NG/ML WITH A DATA FLAG. THESE RESULTS WERE REPORTED OUTSIDE THE LABORATORY. THE SECOND REPEAT CKMB RESULT WHEN DILUTED 1:10 WAS 404.7 NG/ML WITH A DATA FLAG. THE SECOND REPEAT TROPONIN I RESULT WHEN DILUTED 1:10 WAS 197.9 NG/ML WITH A DATA FLAG. THESE RESULTS WERE REPORTED OUTSIDE THE LABORATORY. THE PATIENT WAS NOT ADVERSELY AFFECTED. THE CKMB REAGENT LOT NUMBER WAS 174105 AND THE TROPONIN I REAGENT LOT NUMBER WAS 174423. THE EXPIRATION DATES WERE REQUESTED, BUT WERE NOT PROVIDED.

N

Patient 1

A SPECIFIC ROOT CAUSE COULD NOT BE IDENTIFIED. ADDITIONAL INFORMATION FOR FURTHER INVESTIGATION WAS REQUESTED BUT WAS NOT PROVIDED. BASED ON THE PROVIDED CALIBRATION DATA, GENERAL REAGENT ISSUES WERE NOT SUSPECTED.

N

Patient 1

INFORMATION CONCERNING THE SPECIFIC PART NUMBER INVOLVED IN THIS EVENT WAS REQUESTED, BUT WAS NOT PROVIDED. THIS EVENT OCCURRED IN (B)(6).