ELECSYS INSULIN

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-01-28 for ELECSYS INSULIN manufactured by Roche Diagnostics.

Event Text Entries

[134351956] The investigation results are not yet available. The follow up/corrective actions are not yet available. No devices were returned. This device is not labeled for single use and is not reprocessed or reused.
Patient Sequence No: 1, Text Type: N, H10

[134351957] This report summarizes 1 malfunction event. Low results were generated by the cobas 8000 e 602 module. The event involved 1 patient with low results for elecsys insulin. The patient's age was requested, but was not provided. The patient's weight was requested, but was not provided. The patient's gender was requested, but was not provided. The patient's race was requested, but was not provided. The patient's ethnicity was requested, but was not provided.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: 1823260-2019-90040
• MDR Report Key: 8280769
• Date Received: 2019-01-28
• Date Added to Maude: 2019-01-28
• 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
• Health Professional: 0
• Initial Report to FDA: 0
• Report to FDA: 3
• Event Location: 3
• Manufacturer Contact: 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: SANDHOFFERSTRASSE 116 NA
• Manufacturer City: MANNHEIM (BADEN-WURTTEMBERG), NA 68305
• Manufacturer Country: GM
• Manufacturer Postal Code: 68305
• Single Use: 3
• Previous Use Code: 3
• Event Type: 3
• Type of Report: 0

Device Details

• Brand Name: ELECSYS INSULIN
• Generic Name: IMMUNOREACTIVE INSULIN TEST SYSTEM
• Product Code: CFP
• Date Received: 2019-01-28
• Model Number: INSULIN
• Lot Number: ASKU
• Device Availability: *
• Device Age: DA
• Device Eval'ed by Mfgr: *
• Device Sequence No: 1
• Device Event Key: 0
• Manufacturer: ROCHE DIAGNOSTICS
• Manufacturer Address: 9115 HAGUE ROAD NA INDIANAPOLIS IN 46250 US 46250

Patients

Patient Number	Treatment	Outcome	Date
1	0		2019-01-28