BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CHECK-IT

    MDR report key: 15238361 · Received August 17, 2022

    Report

    Report Number
    3016521623-2022-00284
    Event Type
    Malfunction
    Date Received
    August 17, 2022
    Date of Event
    August 3, 2022
    Report Date
    August 12, 2022
    Manufacturer
    LUCIRA HEALTH, INC.
    Product Code
    QJR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 0

    PRODUCT HAS NOT BEEN RETURNED. THEREFORE, A DHR REVIEW WAS COMPLETED FOR KIT LOT NUMBER K08A111104224M1 WITH 0 DISCREPANCIES FOUND (ALL LOTS PASSED IN TOTAL PER THE SAMPLING PLAN). A REVIEW OF EXISTING CAPAS, SCARS AND NCMRS WERE COMPLETED AND THERE ARE NO PRIOR RECORDS RELATED TO "FALSE POSITIVE" FAILURE MODE FOR THIS LOT. THERE IS TWO SIMILAR COMPLAINTS (CP4089/CMP-001302 AND CP4577/CMP-001650) WITH TWELVE ALLEGED FALSE POSITIVES REPORTED FROM TWO DIFFERENT CUSTOMERS ASSOCIATED WITH THE SAME KIT LOT NUMBER K08A111104224M1. A REVIEW INTO THE SIMILAR COMPLAINTS HAVE BEEN COMPLETED TO OBTAIN ADDITIONAL INFORMATION. BASED ON REVIEW OF THE PRODUCT'S FMEAS AND RISK ASSESSMENT DOCUMENTATION, FALSE POSITIVE TEST RESULTS ARE A KNOWN POSSIBLE OUTCOME REGARDING THIS ISSUE UNDER EVALUATION, REFER TO FMEA-001 AND FMEA-004. THE COMPLAINT RATE FOR "FALSE POSITIVE" IS UNDER THE EXPECTED THRESHOLD OF 2% (LABEL CLAIM)/1% (INTERNAL WARNING LIMIT). ACCORDING TO THE FAILURE RATE (B)(4) FOR THIS LOT, THE NUMBER OF FALSE POSITIVES (13-TOTAL FALSE POSITIVES REPORTED FROM SAME LOT) IN RELATION TO THE TOTAL LOT QUANTITY PRODUCED (45,500) IS UNDER THE EXPECTED THRESHOLD. LUCIRA HEALTH WILL CONTINUE TO MONITOR TRENDS RELATED TO FALSE POSITIVE RESULTS IN ACCORDANCE WITH POST-MARKET SURVEILLANCE PROCESS. DHR REVIEW KIT LOT# K08A111104224M1: SAMPLE VIAL LOT DHR REVIEW: 2203438, 2202318, 2203506, 2203231, 2203332 (ASSOCIATED INTERNAL LOT # 220305-1J, 220124-1N, 220305-4D, 220124-7L, 220124-7R) TEST LOT DHRS REVIEW: 2203141, 2203143, 2203141, 2203269, 2203280, 2203282, 2203282, 2203381, 2203448, 2203478, 2203503, 2203503, 2203478, 2203502, 2203502, 2203502, 2203526, 2203577, 2203527, 2203527 (ASSOCIATED INTERNAL LOT # 220305-6N, 220305-6S, 220305-6M, 220305-12N, 220305-12U, 220305-12Y, 220305-12Z, 220305-18F, 220305-21J, 220305-24E, 220305-24L, 220305-24N, 220305-24G, 220305-24I, 220305-24K, 220305-24J, 220305-24X, 220305-27P, 220305-3H, 220305-3I). BASED ON THE LIMITED INFORMATION AVAILABLE, ROOT CAUSE CANNOT BE DETERMINED. POTENTIAL ROOT CAUSES INCLUDE BUT ARE NOT LIMITED TO: ENVIRONMENTAL CONTAMINATION, LOW VIRAL LOAD, AND/OR DEVICE FAILURE. A SUPPLEMENTAL REPORT WILL BE FILED IF ANY FURTHER INVESTIGATION AND/OR ADDITIONAL INFORMATION IS OBTAINED. BASED ON THE COMPLAINT REVIEW, NO HARM WAS REPORTED WITHIN THE COMPLAINT. THIS DEVICE IS MARKETED UNDER (B)(4) CHECK-IT.

    Description of Event or Problem · 0

    ONE DEVICE REPORTED AS HAVING AN ALLEGED FALSE POSITIVE RESULT. THE COMPLAINANT RETESTED WITH AN ADDITIONAL LUCIRA TEST KIT WITH A NEGATIVE RESULT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1543471 CHECK-IT COVID-19 TEST KIT QJR LUCIRA HEALTH, INC. K08A111104224M1

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown Other