FDA Adverse Event Malfunction Summary report: N

INDICAID COVID-19 RAPID ANTIGEN TEST

MDR report key: 16641349 · Received March 30, 2023

Report

Report Number
3017887566-2023-00003
Event Type
Malfunction
Date Received
March 30, 2023
Date of Event
February 18, 2023
Report Date
March 17, 2023
Manufacturer
PHASE SCIENTIFIC INTERNATIONAL LIMITED
Product Code
QKP
PMA / PMN Number
N/AN/A
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
HK
Reporter Occupation
003

Narratives

Description of Event or Problem · 0

ON 17TH MAR 2023, PHASE SCIENTIFIC INTERNATIONAL LTD RECEIVED THE NOTIFICATION FROM FDA ABOUT A MEDWATCH REPORTING ON FALSE NEGATIVE COVID19 RAT RESULT (SEE MDR REPORT# MW5115749). A CUSTOMER, WHO DID NOT DISCLOSE PERSONAL INFORMATION, REPORTED THAT HE FOUND 3 INDICAID COVID 19 RAT TESTS SHOWING NEGATIVE RESULT. HOWEVER, THE CUSTOMER WAS CONFIRMED COVID POSITIVE ON THE SAME DAY IN THE DOCTOR APPOINTMENT. THE NEXT TWO DAYS, THE CUSTOMER CONTINUED GETTING NEGATIVE RESULT FROM INDICAID COVID RAT WHILE POSITIVE THE OTHER BRAND RAT SHOWED POSITIVE IN THE TEST. THERE IS NO PRODUCT LOT # OR CONTACT INFORMATION BEING PROVIDED IN THE MEDWATCH FORM PROVIDED. THERE IS NO HOSPITALIZATION, SEVERE INJURY OR DEATH REPORTED. THE DATE OF OCCURRENCE OF THE ISSUE IS ON (B)(6) 2023. THE DATE OF CUSTOMER REPORTING ON 21ST FEB 2023. PHASE SCIENTIFIC INTERNATIONAL LTD RECEIVED THE REPORT ON 17TH MAR 2023. THERE ARE 3 MORE REPORT (MDR REPORT# MW5115746, MDR REPORT# MW5115747, MDR REPORT# MW5115748) ALL PERTAINING TO THIS SAME COMPAINT. THIS MANUFACTURER MDR REPORT COVERS 4 REPORT FROM THE SAME CUSTOMER ON THE SAME COMPLAINT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
211016 INDICAID COVID-19 RAPID ANTIGEN TEST INDICAID COVID-19 RAPID ANTIGEN TEST QKP PHASE SCIENTIFIC INTERNATIONAL LIMITED N/A

Patients

Seq Age Sex Outcome Treatment
1 Prefer Not To Disclose Other