BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    FT4, FREE THYROXINE

    MDR report key: 4801995 · Received May 28, 2015

    Report

    Report Number
    1823260-2015-03530
    Event Type
    Malfunction
    Date Received
    May 28, 2015
    Date of Event
    May 12, 2015
    Report Date
    June 15, 2015
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    CEC
    PMA / PMN Number
    K961489
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    THIS EVENT OCCURRED IN (B)(6).

    Additional Manufacturer Narrative · 1

    THE PATIENT SAMPLE WAS PROVIDED FOR INVESTIGATION. INVESTIGATION OF THE SAMPLE HAS DETERMINED THERE IS AN INTERFERING FACTOR TO STREPTAVIDIN PRESENT IN THE PATIENT SAMPLE. PRODUCT LABELING DOCUMENTS THIS POTENTIAL INTERFERENCE.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT THEY RECEIVED ERRONEOUS RESULTS FOR ONE PATIENT SAMPLE TESTED FOR THYROTROPIN (TSH), FREE TRIIODOTHYRONINE (FT3), AND FREE THYROXINE (FT4). THE CUSTOMER WAS ASKED, BUT DID NOT PROVIDE THE SPECIFIC DATE OF THE EVENT. THIS MEDWATCH WILL COVER FT4. REFER TO THE MEDWATCH WITH (B)(6) FOR INFORMATION REFERRING TO TSH AND THE MEDWATCH WITH (B)(6) FOR INFORMATION REFERRING TO FT3. THE SAMPLE WAS INITIALLY TESTED AT THE CUSTOMER SITE ON AN E602 ANALYZER AND THEN REPEATED ON A CENTAUR ANALYZER. DURING INVESTIGATIONS, THE PATIENT SAMPLE WAS TESTED ON AN E170 ANALYZER AND AN E411 ANALYZER. IT WAS ASKED, BUT IT IS UNKNOWN WHICH PATIENT RESULTS, IF ANY, WERE REPORTED OUTSIDE OF THE LABORATORY. THE RESULTS FROM THE INVESTIGATION WERE PROVIDED TO THE CUSTOMER. IT WAS ASKED, BUT IT IS NOT KNOWN IF THE PATIENT WAS ADVERSELY AFFECTED. NO ADVERSE EVENTS WERE ALLEGED. THE E602 ANALYZER SERIAL NUMBER USED AT THE CUSTOMER SITE WAS ASKED FOR, BUT NOT PROVIDED. THE E170 ANALYZER USED FOR INVESTIGATION PURPOSES WAS (B)(4). THE FT4 REAGENT LOT NUMBER USED ON THIS ANALYZER WAS 178388, WITH AN EXPIRATION DATE OF JUNE 2015. THE E411 ANALYZER USED FOR INVESTIGATION PURPOSES WAS (B)(4). THE FT4 REAGENT LOT NUMBER USED ON THIS ANALYZER WAS 181732, WITH AN EXPIRATION DATE OF JUNE 2015.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    347234 FT4, FREE THYROXINE RADIOIMMUNOASSAY, FREE THYROXINE CEC ROCHE DIAGNOSTICS NA ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1