BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VITAMIN B12

    MDR report key: 2281147 · Received October 7, 2011

    Report

    Report Number
    1823260-2011-05281
    Event Type
    Malfunction
    Date Received
    October 7, 2011
    Date of Event
    September 22, 2011
    Report Date
    January 26, 2012
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    CDD
    PMA / PMN Number
    K060755
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    THE SUSPECT MEDICAL DEVICE WAS THE VITAMIN B12 REAGENT.

    Additional Manufacturer Narrative · 1

    A ROOT CAUSE COULD NOT BE DETERMINED DUE TO THE LIMITED INFORMATION PROVIDED BY THE CUSTOMER. THE CUSTOMER INDICATED NO FURTHER INFORMATION WILL BE AVAILABLE. THE SITE INDICATED THERE ARE NO CURRENT PROBLEMS WITH THE ANALYZER OR THE B12 ASSAY. NO ADVERSE EVENTS WERE REPORTED.

    Description of Event or Problem · 1

    THE USER RECEIVED A QUESTIONABLE VITAMIN B12 RESULT FOR ONE PATIENT SAMPLE. THE EXACT DATE OF TESTING WAS NOT KNOWN. IT WAS UNKNOWN IF THE ERRONEOUS RESULT WAS GENERATED FROM THIS ANALYZER OR ELECSYS 2010 SERIAL NUMBER (B)(4). SEE THE MEDWATCH WITH PATIENT IDENTIFIER (B)(4) FOR ELECSYS 2010 SERIAL NUMBER (B)(4). THE INITIAL RESULT WAS <31 PG/ML AND THE REPEAT RESULT WAS IN THE NORMAL REFERENCE RANGE OF 211-946 PG/ML. THE EXACT REPEAT RESULT WAS NOT AVAILABLE. ALL OF THE RESULTS WERE REPORTED OUTSIDE THE LABORATORY. THE REPEAT RESULT WAS CONSIDERED TO BE CORRECT. IT WAS UNKNOWN IF THE PATIENT WAS ADVERSELY AFFECTED. THE VITAMIN B12 REAGENT LOT NUMBER WAS NOT PROVIDED. THE USER DECLINED A SERVICE VISIT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VITAMIN B12 RADIOASSAY, VITAMIN B12 CDD ROCHE DIAGNOSTICS NA ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 027 YR