ADVIA CENTAUR XP 078-A011-03

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06 report with the FDA on 2014-09-04 for ADVIA CENTAUR XP 078-A011-03 manufactured by Siemens Healthcare Diagnostics, Inc..

Event Text Entries

[4734789] A discordant, (b)(6) result was obtained on one patient sample on an advia centaur xp instrument run with an automatic sample handling system. The (b)(6) result was considered discordant when the sample was repeated on the same instrument after being manually loaded and resulted (b)(6) multiple times. There are no reports of patient intervention or adverse health consequences due to the discordant (b)(6) result. "
Patient Sequence No: 1, Text Type: D, B5


[12221858] A siemens customer service engineer (cse) was sent to the customer site for instrument inspection. After evaluation of the instrument and instrument data, the cse replaced the sample/ancillary tower. The cause for the discordant (b)(6) result is unknown. The instrument is performing within specifications. Further evaluation of the device is not required.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number2432235-2014-00502
MDR Report Key4061372
Report Source05,06
Date Received2014-09-04
Date of Report2014-08-12
Date of Event2014-08-07
Date Mfgr Received2014-08-12
Device Manufacturer Date2010-03-15
Date Added to Maude2014-09-18
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationMEDICAL TECHNOLOGIST
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactMR. STEPHEN PERRY
Manufacturer Street333 CONEY STREET
Manufacturer CityEAST WALPOLE MA 02032
Manufacturer CountryUS
Manufacturer Postal02032
Manufacturer Phone5086604163
Manufacturer G1SIEMENS HEALTHCARE DIAGNOSTICS MANUFACTURING LTD.
Manufacturer StreetCHAPEL LANE, SWORDS, CO REGISTRATION NUMBER 8020888
Manufacturer CityDUBLIN,
Manufacturer CountryEI
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameADVIA CENTAUR XP
Generic NameIMMUNOASSAY ANALYZER
Product CodeOBF
Date Received2014-09-04
Model NumberADVIA CENTAUR XP
Catalog Number078-A011-03
ID NumberN/A
OperatorMEDICAL TECHNOLOGIST
Device AvailabilityN
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerSIEMENS HEALTHCARE DIAGNOSTICS, INC.
Manufacturer Address511 BENEDICT AVENUE TARRYTOWN NY 10591 US 10591


Patients

Patient NumberTreatmentOutcomeDate
10 2014-09-04

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