MAUDE MDR 6788331

MDR report key
6788331
Report number
2247117-2017-00086
Event key
0
Event type
3
Date of event
2017-07-12
Date received
2017-08-11
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
ROLANDO HUALPA
Address
511 BENEDICT AVE TARRYTOWN NY 10951 US
Phone
914-914-9145
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
0IMMULITEIMMULITESIEMENS HEALTHCARE DIAGNOSTICS INC.JLWIMMULITEN N
1IMMULITEIMMULITESIEMENS HEALTHCARE DIAGNOSTICS INC.JJQIMMULITEN N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-08-110

Event Narratives#

N

Patient 1

THE OPERATOR OF THE IMMULITE INSTRUMENT CALLED THE SIEMENS CUSTOMER CARE CENTER (CCC) TO REPORT A THYROID STIMULATING HORMONE (RAPID TSH) DISCORDANT LOW PATIENT RESULT. THE CCC SPECIALIST INQUIRED ABOUT THE INSTRUMENT PERFORMANCE AND WAS INFORMED THAT ALL MAINTENANCE WAS UP TO DATE. THE OPERATOR CONFIRMED ALL REAGENTS WERE HANDLED IN ACCORDANCE WITH PACKAGE INSERT DIRECTIONS, ALL QUALITY CONTROLS (QC) ARE RESULTING IN RANGE, AND THERE WERE NO ERRORS POSTED AT THE TIME OF TESTING. SINCE THE OPERATOR COULD NOT PERFORM ANY ADDITIONAL TROUBLESHOOTING, THE OPERATOR CALLED BACK AND INFORMED THE CCC THAT REPEAT TESTING WAS PERFORMED TO CONFIRM THE CORRECT PATIENT RESULT. IN ADDITION, THE OPERATOR ALSO CLARIFIED THAT THE AFFECTED SAMPLE WAS FROZEN AND THAWED BETWEEN EACH REPEAT TESTING. THE CCC THEN PROVIDED INSTRUCTIONS TO RUN SEVERAL DIAGNOSTICS TESTS TO ENSURE NO MECHANICAL OR FLUIDIC ISSUES. AFTER THE ALL INSTRUCTIONS WERE PERFORMED, THE OPERATOR CONFIRMED NO AIR OR LEAKS IN FLUIDICS, SYRINGES OPERATE AS NORMAL, PIPETTOR LEVEL SENSING IS OPERATIONAL, AND NO ISSUES WITH THE SUBSTRATE DISPENSE OR WASH SPINNER SPEED. THE CAUSE OF THE DISCORDANT, FALSELY LOW RAPID TSH RESULT ON ONE PATIENT SAMPLE IS UNKNOWN. THE INSTRUMENT IS PERFORMING ACCORDING TO THE SPECIFICATIONS AND NO FURTHER EVALUATION OF THIS DEVICE IS REQUIRED. THE INSTRUMENT WAS MANUFACTURED BEFORE SEPTEMBER 2016, AND UDI NUMBER IS NOT AVAILABLE.

D

Patient 1

A SINGLE THYROID STIMULATING HORMONE (RAPID TSH) DISCORDANT LOW PATIENT RESULT WAS OBTAINED ON AN IMMULITE INSTRUMENT. THE DISCORDANT RESULT WAS REPORTED TO THE HEALTHCARE PRACTITIONER WHO QUESTIONED THE RESULT. THE OPERATOR REPEATED TESTING TWICE AND THE PATIENT SAMPLE RESULTED HIGH. THE 1ST REPEAT RESULT WAS REPORTED TO THE HEALTHCARE PRACTITIONER AND IN LINE WITH THE EXPECTED CLINICAL PROFILE. THERE WERE NO REPORTS OF MEDICAL TREATMENT OR INTERVENTION ADMINISTERED OR WITHHELD BECAUSE OF THE DISCORDANT PATIENT RESULT.