FDA Adverse Event Malfunction Summary report: N

COBAS EGFR MUTATION TEST V2

MDR report key: 12460894 · Received September 13, 2021

Report

Report Number
2243471-2021-03272
Event Type
Malfunction
Date Received
September 13, 2021
Date of Event
April 16, 2021
Report Date
September 13, 2021
Manufacturer
ROCHE MOLECULAR SYSTEMS, INC. - BRANCHBURG
Product Code
OWD
UDI-DI
00875197005448
PMA / PMN Number
P150047
Removal / Correction Number
2243471-08-24-2021-003-C
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
SI
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 0

ROCHE RECEIVED COMPLAINTS FROM CUSTOMERS REPORTING THE GENERATION OF FALSE MUTATION DETECTED RESULTS FOR THE EXON 20 INSERTION (EX20INS) MUTATION WHEN USING THE COBAS® EGFR MUTATION TEST V2. DURING IN-HOUSE TESTING USING CUSTOMER-PROVIDED FFPET SAMPLES, AN EX20INS FALSE MUTATION DETECTED RESULT WAS REPRODUCED FOR ONE OUT OF 8 FFPET SAMPLES, WHICH WAS PROCESSED FOLLOWING THE VALIDATED SAMPLE PREPARATION METHOD FROM THE INSTRUCTIONS FOR USE. ALTHOUGH THE MAJORITY OF CASES REPORTED WERE FROM USERS USING FFPET SAMPLES, THE GENERATION OF FALSE MUTATION DETECTED EX20INS RESULTS WITH PLASMA SPECIMENS WAS REPORTED IN ONE CASE. A FALSE MUTATION DETECTED EX20INS RESULT COULD LEAD TO HARM UNDER SPECIFIC SCENARIOS. CONSIGNEES WILL BE NOTIFIED OF THE ISSUE WITH INSTRUCTION TO FOLLOW THE INSTRUCTIONS FOR USE FOR SAMPLE INPUT REQUIREMENTS. ADDITIONALLY, IF AN EX20INS MUTATION DETECTED RESULT IS GENERATED WITH THE COBAS® EGFR MUTATION TEST V2, CUSTOMERS MUST CONFIRM THE RESULT WITH ANOTHER METHOD (E.G., SEQUENCING OR OTHER PCR-BASED TESTS). (B)(6). (B)(4).

Description of Event or Problem · 0

A CUSTOMER IN SLOVENIA REPORTED THE GENERATION OF FALSE MUTATION DETECTED RESULTS FOR EXON20 INSERTION MUTATION FOR SEVERAL SAMPLES THAT WERE TESTED WITH THE COBAS EGFR MUTATION TEST V2 (LOTS G05117 AND G25391). SOME OF THE SAMPLE TYPES, SPECIFICALLY CYTOLOGICAL SAMPLES, WERE NOT VALIDATED FOR USE WITH THE COBAS EGFR MUTATION TEST, V2 AND FOR ON-LABEL SAMPLES (FFPET), THE SITE WAS USING MORE THAN ONE 5-MICRO FFPET SAMPLE DURING THEIR PREPARATION PROCESS. NO HARM OR INJURY WAS INDICATED. TWO MDRS WILL BE FILED, ONE FOR EACH ALLEGED KIT LOT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1359958 COBAS EGFR MUTATION TEST V2 SOMATIC GENE MUTATION DETECTION SYSTEM OWD ROCHE MOLECULAR SYSTEMS, INC. - BRANCHBURG NA G25391 00875197005448

Patients

Seq Age Sex Outcome Treatment
1