FDA Adverse Event Malfunction Summary report: N

ANALYTICAL P MODULE

MDR report key: 1873348 · Received October 19, 2010

Report

Report Number
1823260-2010-06187
Event Type
Malfunction
Date Received
October 19, 2010
Date of Event
September 29, 2010
Report Date
October 19, 2010
Manufacturer
ROCHE DIAGNOSTICS
Product Code
JJE
PMA / PMN Number
K953239
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MI, US
Reporter Occupation
HEALTH PROFESSIONAL

Narratives

Description of Event or Problem · 1

THE USER DISCOVERED QUESTIONABLE PHOSPHORUS RESULTS WHEN A DOCTOR QUESTIONED THE HIGH RESULT FOR ONE PATIENT SAMPLE. OF THE DATA PROVIDED, THE RESULTS FOR NINE PATIENT SAMPLES WERE DISCREPANT. THE REPEAT TESTING WAS PERFORMED ON ANALYTICAL P MODULE SERIAL NUMBER (B)(4). ALL RESULTS ARE IN MG/DL. PATIENT SAMPLE 1 INITIAL RESULT WAS 6.8, REPEAT RESULT WAS 3.0. PATIENT SAMPLE 2 INITIAL RESULT WAS 10.3, REPEAT RESULT WAS 3.7. PATIENT SAMPLE 3 INITIAL RESULT WAS 6.9, REPEAT RESULT WAS 3.8. PATIENT SAMPLE 4 INITIAL RESULT WAS 6.1, REPEAT RESULT WAS 3.1. PATIENT SAMPLE 5 INITIAL RESULT WAS 7.8, REPEAT RESULT WAS 3.6. PATIENT SAMPLE 6 INITIAL RESULT WAS 8.3, REPEAT RESULT WAS 4.2. PATIENT SAMPLE 7 INITIAL RESULT WAS 7.5, REPEAT RESULT WAS 3.4. PATIENT SAMPLE 8 INITIAL RESULT WAS 6.7, REPEAT RESULT WAS 3.5. PATIENT SAMPLE 9 INITIAL RESULT WAS 6.5, REPEAT RESULT WAS 3.4. THE INITIAL RESULTS WERE REPORTED OUTSIDE THE LABORATORY AND CORRECTED REPORTS WERE SENT OUT. NO ONE WAS TREATED BECAUSE OF THE INITIAL RESULTS. THE PHOSPHORUS REAGENT LOT NUMBER WAS 62701801. THE FIELD SERVICE REPRESENTATIVE DETERMINED THE VACUUM WAS WEAK AND REPLACED THE VACUUM DIAPHRAGM AND ALL THE VACUUM TUBING ON THE RINSE MECHANISMS. TO VERIFY THE ANALYZER OPERATION, THE USER RAN CALIBRATION AND QUALITY CONTROL WITH RESULTS WITHIN SPECIFICATION. THE FIELD SERVICE REPRESENTATIVE RAN PRECISION TESTING.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ANALYTICAL P MODULE CLINICAL CHEMISTRY ANALYZER JJE ROCHE DIAGNOSTICS NA NA

Patients

Seq Age Sex Outcome Treatment
1