IMMULITE 2000 THYROGLOBULIN L2KTY

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,user faci report with the FDA on 2018-04-27 for IMMULITE 2000 THYROGLOBULIN L2KTY manufactured by Siemens Healthcare Diagnostics Products, Limited.

Event Text Entries

[107077307] A siemens customer service engineer (cse) was dispatched to the customer site. The instrument files for the immulite 2000 system were checked and the adjustment and quality control samples were reviewed. There were no problems identified with the instrument. The customer will continue to monitor the instrument. The instrument is performing within specifications. The cause of the discordant thyroglobulin result(s) is unknown. Siemens is investigating the issue. Mdr 2432235-2018-00186 is being filed for the same event.
Patient Sequence No: 1, Text Type: N, H10


[107077308] Discordant results were obtained on a patient sample for the thyroglobulin (tg) assay on an immulite 2000 instrument when using kit lot 357. The sample was run neat with kit lot 353 and the result was high. A new blood draw from the same patient was run on the same instrument using kit lot 357 and the result was lower. The sample was repeated again on a different date (unknown if it was the initial sample or the sample from the new blood draw, or another new blood draw) on the same immulite 2000 instrument and the result was lower. The tg kit lot used to re-run the sample was not provided. The lower results were questioned by the physician(s). All the results were reported to the physician(s). It is unknown which of the results is the expected result on the patient sample. There are no known reports of patient intervention or adverse health consequences to the patient due to the discordant thyroglobulin results.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2432235-2018-00187
MDR Report Key7469702
Report SourceHEALTH PROFESSIONAL,USER FACI
Date Received2018-04-27
Date of Report2018-06-05
Date of Event2018-04-06
Date Mfgr Received2018-05-24
Date Added to Maude2018-04-27
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactAARTI AZIZ
Manufacturer Street511 BENEDICT AVENUE
Manufacturer CityTARRYTOWN NY 10591
Manufacturer CountryUS
Manufacturer Postal10591
Manufacturer Phone9145242683
Manufacturer G1SIEMENS HEALTHCARE DIAGNOSTICS PRODUCT, LIMITED
Manufacturer StreetREGISTRATION # 3002806944 GLYN RHONWY
Manufacturer CityLLANBERIS, GWYNEED LL55 4EL
Manufacturer CountryUK
Manufacturer Postal Code4EL
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameIMMULITE 2000 THYROGLOBULIN
Generic NameIMMULITE 2000 THYROGLOBULIN
Product CodeMSW
Date Received2018-04-27
Catalog NumberL2KTY
Lot NumberUNKNOWN
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerSIEMENS HEALTHCARE DIAGNOSTICS PRODUCTS, LIMITED
Manufacturer AddressGLYN RHONWY LLANBERIS, GWYNEDD LL55 4EL UK 4EL


Patients

Patient NumberTreatmentOutcomeDate
10 2018-04-27

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