MAUDE MDR 4256384

MDR report key
4256384
Report number
2247117-2014-00078
Event key
0
Event type
3
Date of event
2014-10-13
Date received
2014-11-17
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
CASSANDRA KOCSIS
Address
511 BENEDICT AVENUE TARRYTOWN NY 10591 US
Phone
914-914-9145
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1IMMULITE 2000IMMULITE 2000SIEMENS HEALTHCARE DIAGNOSTICS INC.JJQIMMULITE 200030002N N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-11-170

Event Narratives#

D

Patient 1

THE CUSTOMER HAS OBTAINED OUT OF RANGE VALUES FOR QUALITY CONTROL (QC) SAMPLES ON THE DEHYDROEPIANDROSTERONE SULFATE (DHEA-SO4) ASSAY ON AN IMMULITE 2000 INSTRUMENT. PATIENT SAMPLE VALUES WERE REPORTED TO PHYSICIAN(S) DESPITE QC LEVELS 1 AND 2 BEING OUT OF RANGE HIGH, AND QC LEVEL 3 BEING OUT OF RANGE LOW. DISCORDANT (DHEA-SO4) RESULTS WERE OBTAINED FOR FOUR PATIENT SAMPLES. THE SAMPLES WERE REPEATED ON SAME INSTRUMENT FOR ALL FOUR PATIENTS AND CORRECTED RESULTS WERE OBTAINED. THE CORRECTED RESULTS WERE REPORTED TO THE PHYSICIAN(S). THERE ARE NO REPORTS OF PATIENT INTERVENTION OR ADVERSE HEALTH CONSEQUENCES DUE TO THE DISCORDANT DHEA SO4 RESULTS.

N

Patient 1

THE CUSTOMER CONTACTED THE SIEMENS CUSTOMER CARE CENTER (CCC) AND REPORTED THAT QUALITY CONTROL (QC) WAS OUT OF RANGE. A SIEMENS CUSTOMER SERVICE ENGINEER (CSE) WAS DISPATCHED TO THE CUSTOMER'S SITE. THE CSE EVALUATED THE INSTRUMENT AND INSTALLED PREVENTIVE MAINTENANCE KIT. THE CSE ALSO RAN DECONTAMINATION ON THE WATER PUMP, WASH PROBE TUBING AND SUBSTRATE TOWER AND HEATER. CSE RAN WATER TEST AND QC. THE CAUSE OF DISCORDANT DHEA SO4 RESULTS IS UNKNOWN. THE CAUSE OF DISCORDANT PATIENT RESULTS BEING REPORTED TO PHYSICIAN(S) WHILE QC WAS OUT OF RANGE IS A FAILURE TO FOLLOW INSTRUCTIONS. AS PER THE IMMULITE 2000 DHEA SO4 INSTRUCTIONS FOR USE "USE CONTROLS OR SERUM POOLS WITH AT LEAST TWO LEVELS (LOW AND HIGH) OF DHEA-SO4". THE INSTRUMENT IS PERFORMING ACCORDING TO SPECIFICATIONS. NO FURTHER EVALUATION OF THE DEVICE IS REQUIRED.