BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CHECK-IT

    MDR report key: 16841329 · Received April 30, 2023

    Report

    Report Number
    3016521623-2023-00400
    Event Type
    Malfunction
    Date Received
    April 30, 2023
    Date of Event
    April 17, 2023
    Report Date
    June 16, 2023
    Manufacturer
    PFIZER, INC.
    Product Code
    QJR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 0

    BASED ON INVESTIGATION OF THIS COMPLAINT, NO HARMS REPORTED. PRODUCT HAS NOT BEEN RETURNED. THEREFORE, A DHR REVIEW WAS COMPLETED FOR KIT LOT NUMBER K08A111412213M4 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 17 APRIL 2023. DHR REVIEW FOR KIT LOT NUMBER K08A111412213M4: SAMPLE VIAL LOT DHR REVIEW: 2111349 (ASSOCIATED INTERNAL LOT # 210762-2IA), 2111350 (ASSOCIATED INTERNAL LOT # 210762-2IB), 2111375 (ASSOCIATED INTERNAL LOT # 210762-2IN). TEST LOT DHRS REVIEW: 2112156 (ASSOCIATED INTERNAL LOT # 210762-24V), 2111353 (ASSOCIATED INTERNAL LOT # 210762-20K), 2111353 (ASSOCIATED INTERNAL LOT # 210762-20L), 2111353 (ASSOCIATED INTERNAL LOT # 210762-20M), 2111378 (ASSOCIATED INTERNAL LOT # 210762-20N), 2111378 (ASSOCIATED INTERNAL LOT # 210762-20O), 2111378 (ASSOCIATED INTERNAL LOT # 210762-20S), 2112003 (ASSOCIATED INTERNAL LOT # 210762-20U), 2112003 (ASSOCIATED INTERNAL LOT # 210762-20X), 2112003 (ASSOCIATED INTERNAL LOT # 210762-20Y), 2111376 (ASSOCIATED INTERNAL LOT # 210762-2IC), 2111376 (ASSOCIATED INTERNAL LOT # 210762-2IG), 2112001 (ASSOCIATED INTERNAL LOT # 210762-2IN). 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). PFIZER WILL CONTINUE TO MONITOR TRENDS RELATED TO FALSE POSITIVE RESULTS IN ACCORDANCE WITH POST-MARKET SURVEILLANCE PROCESS. 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 (B)(4) LUCIRA CHECK-IT COVID-19 TEST KIT. ADDITION INFORMATION UPDATED: 1. SECTION B4: DATE OF THIS REPORT: 16-JUN-2023. 2. SECTION D3: A. CHANGED MANUFACTURER NAME: PFIZER, INC. B. UPDATED ADDRESS: 1315 63RD ST., EMERYVILLE, CA 94608, USA. 3. SECTION D4: A. ADDED LOT #: K08A111412213M4. B. ADDED EXPIRATION DATE: 11/19/2022. 4. SECTION E1: NAME AND ADDRESS: ADDED COMPLAINANT'S ADDRESS: 5850 W 3RD ST. #343, LOS ANGELES, CA 90036. 5. SECTION G1: A. UPDATED ADDRESS: 1315 63RD ST., EMERYVILLE, CA 94608, USA. B. CHANGED CONTACT OFFICE: PFIZER, INC. 6. SECTION G6: SELECTED "FOLLOW-UP" AND ADDED "001." 7. SECTION H4: ADDED DEVICE MANUFACTURE DATE: 12/14/2021. 8. SECTION H6: A. TYPE OF INVESTIGATION: REMOVED 4119, ADDED 4109 AND 3331. B. INVESTIGATION FINDINGS: REMOVED 3221, ADDED 213. 9. SECTION H11: CORRECTED DATA: IMPACTED KIT NUMBER WAS PROVIDED, UPDATED THE INVESTIGATION SUMMARY REPORT.

    Additional Manufacturer Narrative · 0

    BASED ON INVESTIGATION OF THIS COMPLAINT, NO HARMS REPORTED. A DHR REVIEW CANNOT BE COMPLETED AS LOT INFORMATION WAS NOT PROVIDED. THE REVIEW OF TRENDING DATA FOR THE FAILURE MODE (FALSE POSITIVE) WAS COMPLETED. 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). (INTERNAL WARNING LIMIT). LUCIRA HEALTH WILL CONTINUE TO MONITOR TRENDS RELATED TO FALSE POSITIVE RESULTS. 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. THIS DEVICE IS MARKETED UNDER EUA (B)(4) CHECK-IT.

    Description of Event or Problem · 0

    ONE DEVICE REPORTED AS HAVING ALLEGED FALSE POSITIVE RESULT. THE COMPLAINANT MENTIONED THE USER TOOK 5 TESTS WITH NEGATIVE RESULTS FOR CONFIRMATION.

    Description of Event or Problem · 0

    ONE DEVICE REPORTED AS HAVING ALLEGED FALSE POSITIVE RESULT. THE COMPLAINANT MENTIONED THE USER TOOK 5 TESTS WITH NEGATIVE RESULTS FOR CONFIRMATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1349923 CHECK-IT COVID-19 TEST KIT QJR PFIZER, INC. K08A111412213M4

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown Other