MAUDE MDR 6327586

MDR report key
6327586
Report number
2432235-2017-00120
Event key
0
Event type
3
Date of event
2017-01-20
Date received
2017-02-13
Adverse event
0
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
TIMOTHY RICE
Address
511 BENEDICT AVE TARRYTOWN NY 10591 US
Phone
914-914-9145
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
0ADVIA CENTAUR XPCLINICAL CHEMISTRY ANALYZERSIEMENS HEALTHCARE DIAGNOSTICS INC.DHXADVIA CENTAUR XPN N
1ADVIA CENTAUR XPCLINICAL CHEMISTRY ANALYZERSIEMENS HEALTHCARE DIAGNOSTICS INC.JJEADVIA CENTAUR XPN N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-02-130

Event Narratives#

N

Patient 1

A SIEMENS'S CUSTOMER SERVICE ENGINEER (CSE) WAS DISPATCHED TO THE CUSTOMER'S SITE. THE CSE PERFORMED A TOTAL SERVICE CALL. THE CSE FOUND THE WASH DISPLACEMENT DILUTER WAS LETTING AIR INTO THE LINE. THE CSE REPLACED AND PRIMED THE WASH DISPLACEMENT DILUTER. THE CUSTOMER PERFORMED QUALITY CONTROL (QC), RESULTING IN RANGE. A SIEMENS HEADQUARTERS SUPPORT CENTER (HSC) SPECIALIST REVIEWED THE EVENT. HSC STATED THAT THE WASH DISPLACEMENT DISPENSE IS NOT USED FOR THE CARCINOEMBRYONIC ANTIGEN METHOD. THIS EVENT WAS THE ONLY INSTANCE OF A DISCORDANT RESULT AND WAS NOT REPRODUCED. THE CAUSE OF THE DISCORDANT, FALSELY DEPRESSED CARCINOEMBRYONIC ANTIGEN RESULT IS UNKNOWN. THE INSTRUMENT IS PERFORMING ACCORDING TO SPECIFICATIONS. NO FURTHER EVALUATION OF THE DEVICE IS REQUIRED.

D

Patient 1

A DISCORDANT, FALSELY DEPRESSED CARCINOEMBRYONIC ANTIGEN RESULT WAS OBTAINED ON A PATIENT SAMPLE ON AN ADVIA CENTAUR XP INSTRUMENT. THE INITIAL RESULT WAS REPORTED OUT TO THE PHYSICIAN(S), WHICH WAS QUESTIONED. THE CUSTOMER REPEATED THE SAME SAMPLE ON THE SAME ADVIA CENTAUR INSTRUMENT TWICE, RESULTING HIGHER. THE CUSTOMER FILED A CORRECTED REPORT TO THE PHYSICIAN(S). THERE ARE NO KNOWN REPORTS OF PATIENT INTERVENTION OR ADVERSE HEALTH CONSEQUENCES DUE TO THE DISCORDANT, FALSELY DEPRESSED CARCINOEMBRYONIC ANTIGEN RESULT.