BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    FT3 - FREE TRIIODOTHYRONINE

    MDR report key: 5041721 · Received August 31, 2015

    Report

    Report Number
    1823260-2015-04048
    Event Type
    Malfunction
    Date Received
    August 31, 2015
    Date of Event
    August 11, 2015
    Report Date
    August 31, 2015
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    CDP
    PMA / PMN Number
    K963127
    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).

    Description of Event or Problem · 1

    THE CUSTOMER QUESTIONED RESULTS FROM 1 PATIENT SAMPLE TESTED FOR THYROTROPIN (TSH), FREE THYROXINE (FT4) AND FREE TRIIODOTHYRONINE (FT3). THE CUSTOMER PROVIDED THE SAMPLE FOR INVESTIGATION. OF THE DATA PROVIDED, ERRONEOUS FT4 AND FT3 RESULTS WERE IDENTIFIED BETWEEN THE CUSTOMER'S E602 ANALYZER, AN E 170 ANALYZER USED AT THE INVESTIGATION SITE AND AN E411 ANALYZER USED AT THE INVESTIGATION SITE. THE DATE OF TESTS PERFORMED AT THE CUSTOMER SITE IS NOT KNOWN. IT IS NOT KNOWN IF ERRONEOUS RESULTS WERE REPORTED OUTSIDE OF THE LABORATORY. THIS MEDWATCH WILL COVER FT3. REFER TO MEDWATCH WITH PATIENT IDENTIFIER (B)(4) FOR INFORMATION ON THE FT4 ERRONEOUS RESULTS. REFER TO THE DATA FOR PATIENT RESULTS. NO ADVERSE EVENT WAS REPORTED. THE E 170 ANALYZER SERIAL NUMBER WAS (B)(4). THE E411 ANALYZER SERIAL NUMBER WAS 13(B)(4). THE FT3 REAGENT LOT NUMBER USED AT THE INVESTIGATION SITE WAS 183221 WITH AN EXPIRATION DATE OF 01/31/2016. THE SERIAL NUMBER FOR THE CUSTOMER'S E602 ANALYZER IS NOT KNOWN. A SPECIFIC ROOT CAUSE COULD NOT BE IDENTIFIED. THERE WAS NOT ENOUGH SAMPLE VOLUME LEFT TO COMPLETE THE INVESTIGATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    574562 FT3 - FREE TRIIODOTHYRONINE RADIOIMMUNOASSAY, TOTAL TRIIODOTHYRONINE CDP ROCHE DIAGNOSTICS NA ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1