FDA Adverse Event Malfunction Summary report: N

ACCESS 2 IMMUNOASSAY SYSTEM

MDR report key: 2172103 · Received June 15, 2011

Report

Report Number
2122870-2011-01803
Event Type
Malfunction
Date Received
June 15, 2011
Date of Event
September 5, 2007
Report Date
October 29, 2007
Manufacturer
BECKMAN COULTER, INC.
Product Code
MMI
PMA / PMN Number
K922823/A007
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

CUSTOMER TECHNICAL SUPPORT (CTS) INFORMED THE CUSTOMER OF THE POTENTIAL BIOHAZARDS AND SAFETY HAZARDS ASSOCIATED WITH TROUBLESHOOTING WHICH MAY INCLUDE A POTENTIAL FOR SHOCK, PUNCTURE OR PINCH AND ADVISED THE CUSTOMER TO REMOVE JEWELRY AND USE PROPERLY INSTALLED TOOLS TO MINIMIZE RISKS. THE CUSTOMER UNDERSTOOD AND AGREED TO CONTINUE TROUBLESHOOTING. CTS GUIDED THE CUSTOMER THROUGH FLUSHING THE VACUUM PUMP, AND THE VACUUM TEST SUCCESSFULLY PASSED. THE UNIT WAS RETURNED TO OPERATION. SAMPLES WERE NOT AVAILABLE FOR ADD'L TESTING. CLINICAL HISTORY WAS NOT SUPPLIED. SAMPLE TYPES AND PROCESSING DETAILS WERE NOT SUPPLIED. SYSTEM CHECK RESULTS FROM (B)(6) 2007 ON SYSTEM SERIAL NUMBER (B)(4) WERE SUPPLIED AND ALL RESULTS MET THE MFR'S SPECS. QUALITY CONTROL (QC) HISTORY WAS NOT SUPPLIED. THE CUSTOMER DID NOT PROVIDE WHICH SYSTEM THE RESULTS OCCURRED ON. FOR ASSAYS EMPLOYING MOUSE ANTIBODIES, THE POSSIBILITY EXISTS FOR INTERFERENCE BY HUMAN ANTI-MOUSE ANTIBODIES (HAMA) IN THE SAMPLE. HUMAN ANTI-MOUSE ANTIBODIES MAY BE PRESENT IN SAMPLES FROM PTS WHO HAVE RECEIVED IMMUNOTHERAPY OR DIAGNOSTIC PROCEDURES UTILIZING MONOCLONAL ANTIBODIES OR IN INDIVIDUALS WHO HAVE BEEN REGULARLY EXPOSED TO ANIMALS. ADDITIONALLY, OTHER HETEROPHILE ANTIBODIES, SUCH AS HUMAN ANTI-GOAT ANTIBODIES, MAY BE PRESENT IN PT SAMPLES. IN ADDITION, ELEVATED TROPONIN-I LEVELS HAVE ALSO BEEN DOCUMENTED IN CASES IN OTHER CARDIAC CONDITIONS SUCH AS UNSTABLE ANGINA, CONGESTIVE HEART FAILURE, OR MYOCARDITIS, OR SEVERE NON-CARDIAC CONDITIONS SUCH AS TRAUMA OR RENAL FAILURE THAT MAY CAUSE CARDIAC MUSCLE INJURY. THUS TROPONIN (ACCUTNI) RESULTS SHOULD BE INTERPRETED IN LIGHT OF THE TOTAL CLINICAL PRESENTATION OF THE PT, INCLUDING: SYMPTOMS, CLINICAL HISTORY, CLINICAL EXAMINATION, ELECTROCARDIOGRAM (ECG), DATA FROM ADD'L TESTS, AND OTHER APPROPRIATE INFO. MED DECISIONS SHOULD NOT BE BASED ON A SINGLE ACCUTNI DETERMINATION AT ONE TIME POINT. THIS REPORTABLE EVENT WAS IDENTIFIED DURING A RETROSPECTIVE REVIEW OF PRODUCT COMPLAINTS CONDUCTED BETWEEN (B)(6) 2008 THROUGH (B)(6) 2010 FOR ADD'L REPORTABLE EVENTS. THIS MEDWATCH REPORT IS RELATED TO MDRS: 2122870-2011-01800, 01801, AND 01802.

Description of Event or Problem · 1

THE CUSTOMER REPORTED ELEVATED TROPONIN (ACCUTNI) PT RESULTS INVOLVING ACCESS 2 IMMUNOASSAY SYSTEM. THE CUSTOMER DID NOT KNOW WHICH ACCESS 2 IMMUNOASSAY SYSTEM THE RESULTS OCCURRED ON. THIS IS REPORT NUMBER FOUR OF FOUR REFERENCING SYSTEM SERIAL NUMBER (B)(4). VALUES OBTAINED WERE ABOVE THE ACUTE MYOCARDIAL INFARCTION (AMI) CUTOFF AND NEGATIVE VIA AN ALTERNATE METHODOLOGY. VALUES REMAINED ELEVATED WITH A NEW DRAW TWO MONTHS AFTER. THE CUSTOMER SUSPECTED HETEROPHILE INTERFERENCE BUT DID NOT PERFORM ADD'L TESTING, AND STATED THE RESULTS WERE ELEVATED AND REPRODUCIBLE. THE ELEVATED RESULTS WERE RELEASED OUT OF THE LAB. THERE HAS BEEN NO REPORT OF PT INJURY OR CHANGE IN PT TREATMENT ASSOCIATED WITH THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ACCESS 2 IMMUNOASSAY SYSTEM MMI BECKMAN COULTER, INC. NA NA

Patients

Seq Age Sex Outcome Treatment
1 43 YR ACCESS ACUTNI