BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CHECK-IT

    MDR report key: 15635715 · Received October 19, 2022

    Report

    Report Number
    3016521623-2022-00442
    Event Type
    Malfunction
    Date Received
    October 19, 2022
    Date of Event
    October 5, 2022
    Report Date
    October 20, 2022
    Manufacturer
    LUCIRA HEALTH, INC.
    Product Code
    QJR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 0

    SECTION B #5: DESCRIBE EVENT OR PROBLEM: THE COMPLAINANT REPORTED ONE ALLEGED FALSE POSITIVE RESULT. THE COMPLAINANT PERFORMED A LUCIRA TEST WITH A POSITIVE RESULT. THE COMPLAINANT RETESTED WITH ONE ADDITIONAL RT-LAMP LUCIRA TEST AND ONE LAB PCR TEST WITH NEGATIVE RESULTS FOR CONFIRMATION. SECTION E #1: NAME AND ADDRESS: (B)(6).

    Additional Manufacturer Narrative · 0

    PRODUCT(S) HAVE NOT BEEN RETURNED. THEREFORE, A DHR REVIEW WAS COMPLETED FOR KIT LOT NUMBER K08A112803223M4 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 ARE 0 ADDITIONAL COMPLAINTS FROM THIS CUSTOMER, NOR ANY OTHER CUSTOMER ASSOCIATED WITH A "FALSE POSITIVE" FAILURE MODE PRIOR TO THE REPORTED RECEIPT DATE OF (B)(6) 2022. 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). (B)(4). KIT LOT# K08A112803223M4 DHR REVIEW REFERENCE: SAMPLE VIAL LOT DHR REVIEW: 2203055, 2203305, 2203304 (ASSOCIATED INTERNAL LOT # 210762-25M, 220305-15I, 220305-15E, 220305-15F, 220305-15H, 220305-15G) TEST LOT DHRS REVIEW: 2203302, 2203303 (ASSOCIATED INTERNAL LOT # 220124-7P, 220124-7W) BASED ON THE LIMITED INFORMATION AVAILABLE, ROOT CAUSE CANNOT BE DETERMINED. WITH ANY POTENTIAL FALSE POSITIVE RESULT, THERE ARE SEVERAL POTENTIAL ROOT CAUSES: LOW VIRAL LOAD IN PATIENT SAMPLE THAT IS BELOW THE LOD OF THE LUCIRA AND REFERENCE TEST. AT VIRAL LOADS CLOSE TO LOD A TEST DETECTS A POSITIVE >95% OF THE TIME. WHEN THE VIRAL LOAD IS BELOW LOD, THE FOLLOW-UP TEST CANNOT PICK UP POSITIVE RELIABLY AND CAN GENERATE THE IMPRESSION OF A FALSE POSITIVE RESULT. LOW VIRAL LOADS CAN ALSO RESULT IN SAMPLING VARIABILITY BETWEEN SAMPLES. ENVIRONMENTAL CONTAMINATION FROM OTHER POSITIVES BEING TESTED IN THAT ENVIRONMENT OR DUE TO IMPROPER COLLECTION OR HANDLING OF THE SPECIMEN. DEVICE MALFUNCTION PLEASE NOTE OUR DEVICES ARE EXTENSIVELY INSPECTED AND TESTED THROUGH A ROBUST LOT RELEASE PROCESS AND THIS SCENARIO IS HIGHLY UNLIKELY 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 CHECK-IT LUC_2000 EUA(B)(4) AND CHECK-IT LUC_3000: 1030306.

    Description of Event or Problem · 0

    THE COMPLAINANT REPORTED ONE ALLEGED FALSE POSITIVE RESULT. THE COMPLAINANT PERFORMED A LUCIRA TEST WITH A POSITIVE RESULT. THE COMPLAINANT RETESTED WITH ONE ADDITIONAL RT-LAMP LUCIRA TEST AND ONE LAB PCR TEST WITH NEGATIVE RESULTS FOR CONFIRMATION.

    Description of Event or Problem · 0

    THE COMPLAINANT REPORTED ONE ALLEGED FALSE POSITIVE RESULT. THE COMPLAINANT PERFORMED ONE LUCIRA TEST AND RECEIVED A POSITIVE RESULT CLOSE TO THE 30-MINUTE RUNNING TIME. THE COMPLAINANT RETESTED WITH A LAB PCR TEST WITH A NEGATIVE RESULT FOR CONFIRMATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2028329 CHECK-IT COVID-19 TEST KIT QJR LUCIRA HEALTH, INC. K08A112803223M4

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown Other