FDA Adverse Event Malfunction Summary report: N

DIMENSION VISTA CLINICAL CHEMISTRY SYSTEM

MDR report key: 4792499 · Received May 22, 2015

Report

Report Number
1226181-2015-00288
Event Type
Malfunction
Date Received
May 22, 2015
Date of Event
October 31, 2014
Report Date
May 11, 2015
Manufacturer
SIEMENS HEALTHCARE DIAGNOSTICS INC.
Product Code
JJE
PMA / PMN Number
K051087
Removal / Correction Number
1226181-05/21/2015-002-C
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA, US
Reporter Occupation
HEALTH PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

SIEMENS HEALTHCARE DIAGNOSTICS HAS IDENTIFIED THE FOLLOWING TWO ISSUES USING DIMENSION VISTA INTELLIGENT LAB SYSTEM SOFTWARE VERSIONS 3.6.1, 3.6.1_MU3P, AND 3.6.1SP1. THE FIRST ISSUE IS THAT SAMPLES MAY STOP PROCESSING WITHOUT NOTIFICATION. THE SECOND ISSUE, WHICH CAN ONLY OCCUR ON THE DIMENSION VISTA 1500 SYSTEM, IS UNEXPECTED RESULTS DUE TO A TIMING ISSUE THAT CAUSES A REAGENT SERVER TO TEMPORARILY LOSE SYNCHRONIZATION DURING THE AUTOMATIC REMOVAL OF REAGENT CARTRIDGES FROM REAGENT SERVER 2 TO WASTE A CONTAINER. IN THIS SCENARIO, INCORRECT REAGENT OR NO REAGENT DELIVERY MAY OCCUR. AN URGENT MEDICAL DEVICE CORRECTION (UMDC) WAS SENT TO CUSTOMERS WITHIN THE US IN MAY 2015 AND AN URGENT FIELD SAFETY NOTICE (UFSN) WAS SENT TO CUSTOMERS OUTSIDE THE UNITED STATES IN MAY 2015. THE UMDC AND UFSN ARE FOR THE DIMENSION VISTA 500 INTELLIGENT LAB SYSTEM AND THE DIMENSION VISTA 1500 INTELLIGENT LAB SYSTEM AND ARE ENTITLED "INFORMATION REGARDING VISTA SOFTWARE ISSUES." THE UMDC/UFSN EXPLAIN THESE ISSUES AND PROVIDE ACTIONS CUSTOMERS CAN TAKE IF THEY EXPERIENCE THEM. SIEMENS WILL BE PROVIDING CORRECTIONS FOR THESE ISSUES IN A FUTURE VISTA SOFTWARE VERSION.

Description of Event or Problem · 1

THE OPERATOR OF A DIMENSION VISTA INSTRUMENT DISCOVERED THAT THREE SAMPLE RACKS LOADED ON THE INSTRUMENT WERE NOT PROCESSING AND THE INSTRUMENT INDICATED "NOT STARTED." THE OPERATOR PAUSED THE SYSTEM, THEN CANCELLED THE PAUSE, WHICH RESOLVED THE ISSUE. THERE ARE NO KNOWN REPORTS OF PATIENT INTERVENTION OR ADVERSE HEALTH CONSEQUENCES DUE TO THIS ISSUE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
334089 DIMENSION VISTA CLINICAL CHEMISTRY SYSTEM CLINICAL CHEMISTRY ANALYZER JJE SIEMENS HEALTHCARE DIAGNOSTICS INC. DIMENSION VISTA 500

Patients

Seq Age Sex Outcome Treatment
1