FDA Adverse Event Malfunction Summary report: Y

ECHO LUMENA

MDR report key: 20611248 · Received November 5, 2024

Report

Report Number
1034569-2024-00020
Event Type
Malfunction
Date Received
November 5, 2024
Report Date
January 7, 2025
Manufacturer
IMMUCOR, INC.
Product Code
KSZ
UDI-DI
10888234002338
PMA / PMN Number
BK070016
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
WI, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

NO COMMON SPECIFIC ROOT CAUSE OR DEFECT WAS IDENTIFIED. THE CONCLUSION(S) CODE(S) REPORTED HEREIN ARE ASSIGNED ACCORDING TO THE FACTS PRESENTED BY THE AFFECTED CUSTOMER AND IMMUCOR'S ASSESSMENT AND INVESTIGATION OF THOSE FACTS. WHEN POSSIBLE, IMMUCOR ATTEMPTS TO OBTAIN THE ACTUAL SAMPLES AND REAGENTS INVOLVED; RETENTION REAGENTS OF THE SAME LOT THAT WAS INVOLVED IN THE EVENT MAY BE USED DURING THE INVESTIGATION IF INDICATED. ALSO, WHEN POSSIBLE, IMMUCOR USES REMOTE ACCESS TO REVIEW THE RELEVANT DATA ARCHIVED ON THE INSTRUMENT. THE EVENTS REPORTED ON THIS QUARTERLY MALFUNCTION SUMMARY REPORT ARE LIMITED TO THOSE IN WHICH NO PATIENT HARM OCCURRED, AND NO DESIGN DEFECT (OR OTHER SYSTEMIC PROBLEM) WAS IDENTIFIED. THERE IS NO SPECIFIC ACTION THAT USERS ARE EXPECTED TO TAKE TO MITIGATE THE REPORTED DEVICE FAILURE/MALFUNCTION OTHER THAN TO ENSURE THAT PREVENTATIVE MAINTENANCE IS PERFORMED AS INDICATED IN THE INSTRUMENT INSTRUCTIONS. IMMUCOR WILL CONTINUE TO TRACK AND TREND PERFORMANCE AND OPERATIONAL ISSUES SUCH AS DESCRIBED IN THIS QUARTERLY MALFUNCTION SUMMARY REPORT.

Additional Manufacturer Narrative · 0

NO COMMON SPECIFIC ROOT CAUSE OR DEFECT WAS IDENTIFIED. THE CONCLUSION(S) CODE(S) REPORTED HEREIN ARE ASSIGNED ACCORDING TO THE FACTS PRESENTED BY THE AFFECTED CUSTOMER AND IMMUCOR'S ASSESSMENT AND INVESTIGATION OF THOSE FACTS. WHEN POSSIBLE, IMMUCOR ATTEMPTS TO OBTAIN THE ACTUAL SAMPLES AND REAGENTS INVOLVED; RETENTION REAGENTS OF THE SAME LOT THAT WAS INVOLVED IN THE EVENT MAY BE USED DURING THE INVESTIGATION IF INDICATED. ALSO, WHEN POSSIBLE, IMMUCOR USES REMOTE ACCESS TO REVIEW THE RELEVANT DATA ARCHIVED ON THE INSTRUMENT. THE EVENTS REPORTED ON THIS QUARTERLY MALFUNCTION SUMMARY REPORT ARE LIMITED TO THOSE IN WHICH NO PATIENT HARM OCCURRED, AND NO DESIGN DEFECT (OR OTHER SYSTEMIC PROBLEM) WAS IDENTIFIED. THERE IS NO SPECIFIC ACTION THAT USERS ARE EXPECTED TO TAKE TO MITIGATE THE REPORTED DEVICE FAILURE/MALFUNCTION OTHER THAN TO ENSURE THAT PREVENTATIVE MAINTENANCE IS PERFORMED AS INDICATED IN THE INSTRUMENT INSTRUCTIONS. IMMUCOR WILL CONTINUE TO TRACK AND TREND PERFORMANCE AND OPERATIONAL ISSUES SUCH AS DESCRIBED IN THIS QUARTERLY MALFUNCTION SUMMARY REPORT. THREE ADDITIONAL EVENTS ((B)(4)) WERE DETERMINED TO BE REPORTABLE AFTER THE INITIAL QUARTERLY MALFUNCTION SUMMARY REPORT HAD BEEN SUBMITTED; THESE EVENTS WERE INITIALLY ASSESSED AS NOT REPORTABLE, BUT UPON SUBSEQUENT REVIEW WERE DETERMINED TO BE REPORTABLE. THIS CORRECTED QUARTERLY MALFUNCTION SUMMARY REPORT HAS BEEN SUBMITTED IN RESPONSE TO THE AGENCY'S DECEMBER 27, 2024 EMAIL (GEN2400785-S002: REQUEST OF CORRECTIONS OF MDRS SUBMITTED IN SUMMARY FORMAT). MDR REPORT NUMBER 1034569-2024-00020 IS AN INADVERTENTLY SUBMITTED DUPLICATE OF MDR REPORT NUMBER 1034569-2024-00017.

Description of Event or Problem · 0

A REVIEW OF QUARTERLY EVENTS INDICATED THAT FOR TWELVE (12) PATIENT/DONOR SAMPLES TESTED USING THE ECHO LUMENA AUTOMATED BLOOD BANK SYSTEM, A MALFUNCTION OCCURRED RESULTING IN THE INSTRUMENT PRODUCING INCORRECT RESULTS. A REVIEW INDICATED THAT NINE (9) PATIENT SAMPLES AND THREE (3) DONOR SAMPLES TESTED USING THE ECHO LUMENA AUTOMATED BLOOD BANK SYSTEM PRODUCED INACCURATE RESULTS: A MISSED ANTI-C AND ANTI-E FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED ANTI-E FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY ID; A MISSED ANTI-FYA FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED ANTI-FYA FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY ID; A MISSED ANTI-JSA FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY ID; A MISSED ANTI-FYA AND ANTI-KELL FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED ANTI-KELL FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED UNSPECIFIED ANTIBODY FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED ANTI-JKA FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN AND ANTIBODY ID; A MISSED ANTI-E FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN AND ANTIBODY ID; AND UNEXPECTED ABO TYPING RESULTS FOR THREE (3) DONOR SAMPLES.

Description of Event or Problem · 0

A REVIEW OF QUARTERLY EVENTS INDICATED THAT FOR TWELVE (12) PATIENT/DONOR SAMPLES TESTED USING THE ECHO LUMENA AUTOMATED BLOOD BANK SYSTEM, A MALFUNCTION OCCURRED RESULTING IN THE INSTRUMENT PRODUCING INCORRECT RESULTS. A REVIEW INDICATED THAT NINE (9) PATIENT SAMPLES AND THREE (3) DONOR SAMPLES TESTED USING THE ECHO LUMENA AUTOMATED BLOOD BANK SYSTEM PRODUCED INACCURATE RESULTS: A MISSED ANTI-C AND ANTI-E FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED ANTI-E FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY ID; A MISSED ANTI-FYA FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED ANTI-FYA FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY ID; A MISSED ANTI-JSA FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY ID; A MISSED ANTI-FYA AND ANTI-KELL FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED ANTI-KELL FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED UNSPECIFIED ANTIBODY FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN; A MISSED ANTI-JKA FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN AND ANTIBODY ID; A MISSED ANTI-E FOR ONE (1) PATIENT SAMPLE DURING AN ANTIBODY SCREEN AND ANTIBODY ID; AND UNEXPECTED ABO TYPING RESULTS FOR THREE (3) DONOR SAMPLES.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1796586 ECHO LUMENA AUTOMATED BLOOD BANK SYSTEM KSZ IMMUCOR, INC. 10888234002338

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown