MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,health professional,u report with the FDA on 2018-07-13 for ELECSYS CEA ASSAY 04491777190 manufactured by Roche Diagnostics.
[114156821]
This event occurred in (b)(6).
Patient Sequence No: 1, Text Type: N, H10
[114156822]
The customer complained of discrepant elecsys cea assay results for 1 patient on a cobas 8000 e 602 module serial number (b)(4). The cea result was 9. 52 ng/ml on the e 602 module. The cea result was 1. 20 ng/ml on a beckman instrument. The cea result was 3. 63 ng/ml on an abbott instrument. On (b)(6) 2018 a new sample was collected from the patient and the cea result was 8. 81 ng/ml. On (b)(6) 2018 the new sample was tested on a beckman unicel dsl 800 and the cea result was 1. 48 ng/ml. Erroneous results were reported outside of the laboratory. There was no allegation of an adverse event.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1823260-2018-02315 |
| MDR Report Key | 7685504 |
| Report Source | FOREIGN,HEALTH PROFESSIONAL,U |
| Date Received | 2018-07-13 |
| Date of Report | 2018-07-25 |
| Date of Event | 2018-06-04 |
| Date Mfgr Received | 2018-06-28 |
| Date Added to Maude | 2018-07-13 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | NA MICHAEL LESLIE |
| Manufacturer Street | 9115 HAGUE ROAD NA |
| Manufacturer City | INDIANAPOLIS IN 46250 |
| Manufacturer Country | US |
| Manufacturer Postal | 46250 |
| Manufacturer Phone | 3175214343 |
| Manufacturer G1 | ROCHE DIAGNOSTICS GMBH |
| Manufacturer Street | SANDHOFERSTRASSE 116 NA |
| Manufacturer City | MANNHEIM (BADEN-WURTTEMBERG) 68305 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 68305 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ELECSYS CEA ASSAY |
| Generic Name | CARCINOEMBRYONIC ANTIGEN TEST SYSTEM |
| Product Code | DHX |
| Date Received | 2018-07-13 |
| Model Number | NA |
| Catalog Number | 04491777190 |
| Lot Number | 268397 |
| Device Expiration Date | 2018-12-31 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ROCHE DIAGNOSTICS |
| Manufacturer Address | 9115 HAGUE ROAD NA INDIANAPOLIS IN 462500457 US 462500457 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-07-13 |