FDA Adverse Event Malfunction Summary report: N

8031673-2017-00113

MDR report key: 7043778 · Received November 17, 2017

Report

Report Number
8031673-2017-00113
Event Type
Malfunction
Date Received
November 17, 2017
Date of Event
October 20, 2017
Report Date
May 5, 2018
PMA / PMN Number
K971103
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MD, US
Reporter Occupation
HEALTH PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 0

DEVICE EVALUATION BY MANUFACTURER: MULTIPLE ATTEMPTS WERE MADE TO OBTAIN ADDITIONAL INFORMATION FROM THE CUSTOMER WITHOUT ANY SUCCESS. THE FREE THYROXINE ST AIA-PACK FT4 ASSAY SPECIFICATIONS UNDER PAGE 8, STATES THE FOLLOWING: EXPECTED VALUES: EACH LABORATORY SHOULD DETERMINE A REFERENCE INTERVAL WHICH CORRESPONDS TO THE CHARACTERISTICS OF THE POPULATION BEING TESTED. AS WITH ALL DIAGNOSTIC PROCEDURES, CLINICAL RESULTS MUST BE INTERPRETED WITH REGARD TO CONCOMITANT MEDICATIONS ADMINISTERED TO THE PATIENT. REFERENCE RANGES: THE INTERVAL GIVEN HERE WAS DETERMINED IN SERUM SAMPLES FROM 103 APPARENTLY HEALTHY INDIVIDUALS. REFERENCE INTERVAL = 0.75 - 1.54 NG/DL (9.68 - 19.9 PMOL/L). A 13-MONTH COMPLAINT HISTORY REVIEW AND SERVICE HISTORY REVIEW FOR SIMILAR COMPLAINTS WAS PERFORMED FOR SERIAL NUMBER (B)(4), FROM 20-SEP-2016 THROUGH AWARE DATE 20-OCT-2017. THERE WERE NO OTHER SIMILAR EVENTS IDENTIFIED DURING THE SEARCHED PERIOD. THE MOST PROBABLE CAUSE OF THE REPORTED LOW FT4 PATIENT RESULTS IS DUE TO THE CUSTOMER USING A HIGHER REFERENCE RANGE THAN THE ONE SPECIFIED BY TOSOH. ADDITIONAL MANUFACTURER NARRATIVE: TOSOH BIOSCIENCE, INC. IS SUBMITTING ON BEHALF OF THE FOREIGN MANUFACTURER, TOSOH CORPORATION, PER EXEMPTION NUMBER E2017013. SUBMISSION OF THIS REPORT DOES NOT CONSTITUTE AN ADMISSION THAT THE IMPORTER OR MANUFACTURER'S PRODUCT CAUSED OR CONTRIBUTED TO THE EVENT.

Additional Manufacturer Narrative · 0

H.10. ADDITIONAL MANUFACTURER NARRATIVE: TOSOH BIOSCIENCE, INC. IS SUBMITTING ON BEHALF OF THE FOREIGN MANUFACTURER, TOSOH CORPORATION, PER EXEMPTION NUMBER E2017013. SUBMISSION OF THIS REPORT DOES NOT CONSTITUTE AN ADMISSION THAT THE IMPORTER OR MANUFACTURER'S PRODUCT CAUSED OR CONTRIBUTED TO THE EVENT. H.3. DEVICE EVALUATION BY MANUFACTURER: NO CONCLUSION IS YET AVAILABLE; INVESTIGATION IS CURRENTLY IN-PROCESS. CORRECTED DATA: G. 3. REPORT SOURCE: UNDER THE ABOVE SECTION "USER FACILITY" WAS INCORRECTLY SELECTED. THE ONLY REPORT SOURCE IS "HEALTH PROFESSIONAL".

Additional Manufacturer Narrative · 0

ADDITIONAL MANUFACTURER NARRATIVE: TOSOH BIOSCIENCE, INC. IS SUBMITTING ON BEHALF OF THE FOREIGN MANUFACTURER, TOSOH CORPORATION, PER EXEMPTION NUMBER E2017013. DEVICE EVALUATION BY MANUFACTURER: NO CONCLUSION IS YET AVAILABLE; INVESTIGATION IS CURRENTLY IN-PROCESS. ADDITIONAL INFORMATION IS BEING REQUESTED TO THE CUSTOMER.

Description of Event or Problem · 0

N/A.

Description of Event or Problem · 0

ON (B)(6) 2017 A CUSTOMER REPORTED LOWER THAN EXPECTED FREE THYROXINE (FT4) RESULTS ON PATIENT SAMPLES WITH THE AIA-900 INSTRUMENT. THE CUSTOMER REPORTED THAT THEIR LAB NORMAL REFERENCE RANGE FOR FT4 IS 0.8 - 1.8 NG/DL INSTEAD OF TOSOH'S REFERENCE RANGES OF 0.75 - 1.54 NG/DL. THE TECHNICAL SUPPORT SPECIALIST SUGGESTED RUNNING THE CUSTOMER'S DATA INTO THE EP EVALUATOR WITH 20 PATIENT RESULTS AND ASKED FOR THE ORIGINAL FT4 CORRELATION STUDIES. THERE IS NO INDICATION OF ANY PATIENT INTERVENTION OR ADVERSE HEALTH CONSEQUENCES DUE TO THIS EVENT.

Patients

Seq Age Sex Outcome Treatment
1