BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CHECK-IT

    MDR report key: 15481964 · Received September 25, 2022

    Report

    Report Number
    3016521623-2022-00426
    Event Type
    Malfunction
    Date Received
    September 25, 2022
    Date of Event
    September 19, 2022
    Report Date
    September 23, 2022
    Manufacturer
    LUCIRA HEALTH, INC.
    Product Code
    QJR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 0

    PRODUCT HAS NOT BEEN RETURNED AND NO HARM(S) REPORTED. THEREFORE, A DHR REVIEW WAS COMPLETED FOR KIT LOT NUMBER K08A112812214M1 WITH 0 DISCREPANCIES FOUND (ALL LOTS PASSED IN TOTAL PER THE SAMPLING PLAN). A REVIEW OF EXISTING CAPAS, SCARS AND NCMRS WERE COMPLETED FOR BOTH KIT LOT NUMBERS AND THERE WERE NO PRIOR RECORDS RELATED TO "FALSE POSITIVE" FAILURE MODE FOR THESE LOTS. KIT LOT NUMBER K08A112812214M1, HAS ONE SIMILAR COMPLAINT (B)(4) WITH AN ALLEGED FALSE POSITIVE REPORTED FROM A DIFFERENT CUSTOMER ASSOCIATED WITH KIT LOT NUMBER K08A112812214M1. AN INVESTIGATION INTO THESE 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. (B)(4). DHR REVIEW KIT LOT# K08A112812214M1: SAMPLE VIAL LOT DHRS REVIEWED: 2112076, 2112202, 2112121, 2112154, 2112205, 2112287, 2112153, 2112227, 2112122, 2112123, 2112170, 2112203 (ASSOCIATED INTERNAL LOT #S: 210762-2JT, 210762-2KH, 210762-2JO, 210762-2JW, 210762-2KL, 211346.1-1B, 210762-2JV, 210762-2KM, 210762-2JU, 210762-2JX, 210762-2JY, 210762-2KI). TEST LOT DHRS REVIEWED: 2112145, 2112106, 2112156, 2112127, 2112120, 2112165, 2112174, 2112192, 2112233, 2112232, 2112145, 2112043, 2111353, 2112191 (ASSOCIATED INTERNAL LOT #S: 210762-24U, 210762-24P, 210762-24X, 210762-24A, 210762-24L, 210762-24R, 210762-24J, 210762-25C, 210762-24F, 210762-24Y, 210762-25G, 210762-26Z, 210762-24S, 210762-26K, 210762-24G, 210762-24T, 210762-25B, 210762-27A, 210762-23B, 210762-20K, 210762-27E, 210762-25E, 210762-25Q, 210762-24V, 210762-24H, 210762-24W). 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. LUCIRA HEALTH WILL CONTINUE TO MONITOR TRENDS RELATED TO FALSE POSITIVE RESULTS IN ACCORDANCE WITH POST-MARKET SURVEILLANCE PROCESS. 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 EUA (B)(4) CHECK-IT.

    Description of Event or Problem · 0

    THE COMPLAINANT REPORTED AN ALLEGED FALSE POSITIVE RESULT. THE COMPLAINANT RETESTED WITH A NEGATIVE PCR RESULT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2535195 CHECK-IT COVID-19 TEST KIT QJR LUCIRA HEALTH, INC. K08A112812214M1

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown Other