DIMENSION® CLINICAL CHEMISTRY SYSTEM
Report
- Report Number
- 2517506-2012-00052
- Event Type
- Malfunction
- Date Received
- March 13, 2012
- Date of Event
- March 1, 2012
- Report Date
- March 2, 2012
- Manufacturer
- SIEMENS HEALTHCARE DIAGNOSTICS INC - GLASGOW
- Product Code
- JFY
- PMA / PMN Number
- K073055
- Removal / Correction Number
- 2517506-02-22-2013-002-C
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- AZ, US
- Reporter Occupation
- MEDICAL TECHNOLOGIST
Narratives
ANALYSIS OF THE INSTRUMENT AND INSTRUMENT DATA INDICATE THAT THE CAUSE FOR THE FALSELY DEPRESSED CREATININE RESULTS IS UNKNOWN. THE INSTRUMENT IS PERFORMING WITHIN SPECIFICATIONS. NO FURTHER EVALUATION OF THE DEVICE IS REQUIRED.
SIEMENS FILED THE ORIGINAL MDR (B)(4) /2012. ADDITIONAL INFORMATION: SIEMENS HEALTHCARE DIAGNOSTICS INC. HAS CONFIRMED CUSTOMER COMPLAINTS OF FALSELY DEPRESSED ENZYMATIC CREATININE (EZCR) RESULTS WHEN EZCR IS PROCESSED FROM OPEN WELLS OF ENZYMATIC CREATININE (EZCR) FLEX REAGENT CARTRIDGES THAT ARE IN CLOSE PROXIMITY TO OPEN WELLS OF PHOSPHORUS (PHOS) FLEX REAGENT CARTRIDGES. THE FALSELY DEPRESSED EZCR RESULTS ARE CAUSED BY A EZCR REAGENT INTERACTION WITH THE PHOS REAGENT. AN URGENT MEDICAL DEVICE CORRECTION FOR THE PHOS FLEX REAGENT CARTRIDGE (DF61), COMMUNICATION #(B)(4) WAS ISSUED IN (B)(4) 2013 TO IMPACTED CUSTOMERS. THE COMMUNICATION PROVIDED REMEDIAL ACTIONS TO CUSTOMERS TO EITHER AVOID THE REAGENT INTERACTIONS OR TO DISCONTINUE THE USE OF EITHER PHOS OR EZCR ON THEIR DIMENSION SYSTEM.
A GROUP OF FALSELY DEPRESSED CREATININE RESULT WERE OBTAINED ON PATIENT SAMPLES. SOME PATIENT RESULTS WAS REPORTED TO THE PHYSICIAN. QC WAS RUN AND LOW RECOVERIES PROMPTED RERUN OF PRIOR SAMPLES. THE TESTS WERE REPEATED AND HIGHER RESULTS WERE OBTAINED. IT IS UNKNOWN IF PATIENT TREATMENT WAS ALTERED OR PRESCRIBED AS A RESULT OF THE FALSELY DEPRESSED CREATININE RESULTS. THERE WAS NO REPORT OF ADVERSE HEALTH CONSEQUENCES AS A RESULT OF THE FALSELY DEPRESSED CREATININE RESULTS.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | DIMENSION® CLINICAL CHEMISTRY SYSTEM | ENZYMATIC CREATININE FLEX® REAGENT CARTRIDGE | JFY | SIEMENS HEALTHCARE DIAGNOSTICS INC - GLASGOW | GA2323 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |