MAUDE MDR 4379411

MDR report key
4379411
Report number
2023365-2014-00053
Event key
0
Event type
3
Date of event
2011-11-17
Date received
2014-12-29
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
VALERIE CIMMARUSTI, CLS
Address
11331 VALLEY VIEW ST. CYPRESS CA 90630 US
Phone
562-562-5622
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1HERPESELECT 2 ELISA IGGHERPES SIMPLEX VIRUS SER. ASSAYFOCUS DIAGNOSTICS, INC.MXJEL0920GEL0920G113148R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-12-290

Event Narratives#

D

Patient 1

THE PHYSICIAN REPORTED THAT THE ASSAY WAS RUN ON (B)(6) 2011 AND THE INITIAL RESULT WAS (B)(6) WITH AN INDEX 2.88. THE ASSAY WAS RUN AGAIN ON (B)(6) 2011 AND THE RESULT WAS (B)(6) WITH AN INDEX OF 0.06. THE PATIENT SAMPLE WAS STORED AT -20C (SERUM SEPARATED) BETWEEN (B)(6) 2011. BOTH ASSAYS WERE RUN USING THE SAME KIT LOT. BOTH (B)(6) RESULTS WERE REPORTED TO THE DOCTOR, WITH A SPAN OF APPROXIMATELY 2 WEEKS BETWEEN THE REPORTS. IT IS UNKNOWN IF THE PATIENT RECEIVED TREATMENT BASED ON THE (B)(6) TEST RESULT. THIS MDR IS BEING REPORTED FOR A POSSIBLE (B)(6) TEST RESULT FROM THE TESTS PERFORMED ON (B)(6) 2011 FOR THE (B)(6). THIS IS A CONSERVATIVE DECISION, BASED ON THE FACT THAT NEEDED TREATMENT MIGHT BE DISCONTINUED. IF THE PATIENT WAS PREGNANT, IT MAY RESULT IN SERIOUS INDIRECT HARM TO THE FETUS. THE PATIENT INFORMATION IS UNKNOWN.

N

Patient 1

REVIEW OF THE DEVICE HISTORY RECORD FOUND NO NON-CONFORMANCE MATERIAL REPORTS OF DISCREPANCIES DURING THE MANUFACTURE OF THE LOT. NO COMPLAINT TRENDS WERE OBSERVED WITH THE CATALOG NUMBER OR FOR THE LOT. THE CUSTOMER'S RUN FILES WERE REVIEWED AND THE KIT CONTROLS WERE FUNCTIONING PER THE QC PERFORMANCE CRITERIA. NO DISCREPANCIES WERE OBSERVED WITH THE KIT CHEMISTRY. THE CUSTOMER WAS ADVISED TO TROUBLESHOOT THE DSX AUTOMATION WITH RESPECT TO THE PIPETTING OF SAMPLES. THE CUSTOMER WAS ALSO ADVISED TO REPEAT THE RUN MANUALLY, PREFERABLY IN DUPLICATE OR TRIPLICATE. THE LAB SUPERVISOR AGREED WITH THE ANALYSIS. THE USER IS RESPONSIBLE FOR ASSAY PERFORMANCE WHEN AN AUTOMATED SYSTEM IS USED.