MAUDE MDR 4293949

MDR report key
4293949
Report number
2027969-2014-01043
Event key
0
Event type
3
Date of event
2014-10-31
Date received
2014-11-25
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
YA-LING KING
Address
9975 SUMMERS RIDGE RD SAN DIEGO CA 92121 US
Phone
858-858-8588
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ICON 25HCG (COMBO CASSETTE)HCG PREGNANCYALERE SAN DIEGO INCDKZFHC202HCG4040017R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-11-250

Event Narratives#

D

Patient 1

CALLER ALLEGING RECEIVING A FALSE NEGATIVE ON ICON 25 HCG, ONE LOT/PT, URINE SAMPLE. THE CUSTOMER STATES THAT SHE HAD ICON 25 PREGNANCY TEST THAT WAS PERFORMED ON A PT GOING INTO SURGERY AND WAS NEGATIVE. THE CUSTOMER STATES THAT IT WAS FOUND THAT THE PT WAS 12 WEEKS PREGNANT WITH TWINS AFTER THE SURGERY WAS PERFORMED. IT IS UNK WHAT SURGERY WAS PERFORMED. ON FOLLOW-UP, THE CUSTOMER STATED THAT THE SURGERY HAD NO NEGATIVE AFFECT TO THE PT/PREGNANCY. NO REPORT OF ADVERSE PT SEQUELA. NO ADDITIONAL INFO PROVIDED.

N

Patient 1

CUSTOMER'S OBSERVATION WAS NOT REPLICATED IN-HOUSE WITH RETENTION DEVICES. RETENTION DEVICES WERE TESTED WITH 3 HIGH LEVEL HCG URINE CONTROLS. ALL RESULTS WERE POSITIVE AT READ TIME. NO FALSE NEGATIVES WERE OBTAINED. PT WAS 12 WEEKS PREGNANT AND MAY HAVE HAD VERY HIGH LEVELS OF HCG. HOOK EFFECTIVE CANNOT BE RULED OUT AS A CAUSE FOR THE FALSE NEGATIVE. MANUFACTURING BATCH RECORD REVIEW DID NOT UNCOVER ANY ABNORMALITIES. ROOT CAUSE COULD NOT BE DETERMINED WITHOUT PT SPECIMEN IN-HOUSE ANALYSIS. PRODUCT DEFICIENCY WAS NOT ESTABLISHED. AS THERE IS NO INDICATION OF A PRODUCT DEFICIENCY, NO CORRECTIVE ACTION IS REQUIRED AT THIS TIME.