BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CHECK-IT

    MDR report key: 15548976 · Received October 6, 2022

    Report

    Report Number
    3016521623-2022-00427
    Event Type
    Malfunction
    Date Received
    October 6, 2022
    Date of Event
    September 21, 2022
    Report Date
    September 30, 2022
    Manufacturer
    LUCIRA HEALTH, INC.
    Product Code
    QJR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, 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 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. KIT LOT NUMBER K08A110804223M2, HAS THREE SIMILAR COMPLAINTS (B)(4) (1) REPORTED COMPLAINTS BY DIFFERENT COMPLAINANTS) WITH ALLEGED FALSE POSITIVES REPORTED ASSOCIATED WITH KIT LOT NUMBER K08A110804223M2. 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. THE COMPLAINT RATE FOR "FALSE POSITIVE" IS UNDER THE EXPECTED THRESHOLD OF (B)(4) (LABEL CLAIM)/1% (INTERNAL WARNING LIMIT). ACCORDING TO THE FAILURE RATE (B)(4) FOR THIS LOT, THE NUMBER OF FALSE POSITIVES (18-TOTAL FALSE POSITIVE DEVICES REPORTED FROM SAME LOT) IN RELATION TO THE TOTAL LOT QUANTITY PRODUCED (B)(4) IS UNDER THE EXPECTED THRESHOLD. DHR REVIEW KIT LOT# K08A110804223M2: SAMPLE VIAL LOT DHR REVIEW: 2202284, 2202439, 2203407, 2203138, 2203139, 2203158, 2203162, 2203222, 2203302, 2203362, 2203303 (ASSOCIATED INTERNAL LOT # 220124-1I, 220124-4E, 220124-4X, 220124-4V, 220124-4W, 220124-4P, 220124-7A, 220124-7E, 220124-7P, 220124-7X, 220124-7W) TEST LOT DHRS REVIEW: 2203616, 2203243, 2203243, 2203243, 2203245, 2203245, 2203245, 2203246, 2203305, 2203304, 2203304, 2203351, 2203351, 2203352, 2203352, 2203400, 2203351, 2203400, 2203401, 2203414 (ASSOCIATED INTERNAL LOT # 220305-30W, 220305-12C, 220305-12B, 220305-12A, 220305-12H, 220305-12G, 220305-12I, 220305-12K, 220305-15I, 220305-15E, 220305-15G, 220305-15W, 220305-15U, 220305-, 5Z, 220305-15Y, 220305-15S, 220305-15V, 220305-18L, 220305-18M, 220305-18R. 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 PCR AND RAPID ANTIGEN (LOW FLEX) BOTH WITH NEGATIVE RESULTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2150034 CHECK-IT COVID-19 TEST KIT QJR LUCIRA HEALTH, INC. K08A110804223M2

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown Other