BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ALERE DETERMINE HIV-1/2 AG/AB COMBO

    MDR report key: 8645347 · Received May 28, 2019

    Report

    Report Number
    1221359-2019-00030
    Event Type
    Malfunction
    Date Received
    May 28, 2019
    Date of Event
    April 26, 2019
    Report Date
    May 28, 2019
    Manufacturer
    ALERE SCARBOROUGH, INC.
    Product Code
    MZF
    UDI-DI
    10811877010293
    PMA / PMN Number
    BP120037-0
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    TESTING WAS PERFORMED AT ALERE (B)(4) ON RETAINED KIT LOTS 103698 AND 107842 (EXP 21 JULY 2020) WITH THE FOLLOWING INTERNAL SERUM/PLASMA CONTROL SAMPLES: (B)(6) SAMPLES. ALL TEST RESULTS WERE VALID AND PERFORMED AS EXPECTED. ADDITIONALLY, THE MANUFACTURING BATCH RECORDS FOR LOTS 103698 AND 107842 WERE REVIEWED. THIS LOT MET THE REQUIRED RELEASE SPECIFICATIONS. A REVIEW OF THE COMPLAINTS REPORTED AS (B)(6) OR UNCONFIRMED (B)(6) RELATED TO LOT NUMBERS 103698 AND 107842 SHOWED THAT THE COMPLAINT RATE IS (B)(4), RESPECTIVELY. THE EVIDENCE AVAILABLE DOES NOT INDICATE THAT THE PRODUCT IS PERFORMING OUTSIDE LABEL CLAIMS. ALERE (B)(4) WAS UNABLE TO DETERMINE THE EXACT ROOT CAUSE OF THE REPORTED ISSUE. THE RESULTS OBTAINED MAY POSSIBLY BE RELATED TO THE PATIENT SAMPLE. THE SAMPLE MAY HAVE CONTAINED SPECIFIC SUBSTANCES WHICH MAY HAVE AFFECTED THE RESULTS. THE AVAILABLE EVIDENCE SUGGESTS THAT THE DEVICE LOTS ARE PERFORMING WITHIN LABELED CLAIMS.

    Description of Event or Problem · 1

    THIS REPORT REPRESENTS THE SECOND OF THREE (3) (B)(6) ALERE DETERMINE HIV 1/2 AG/AB COMBO PATIENT RESULTS. A (B)(6) RESULT WAS REPORTED ON A SERUM SAMPLE. IT IS NOT SPECIFIED WHICH LOT(S) THE SAMPLE WAS TESTED ON. CONFIRMATORY TESTING BY A 4TH GENERATION HIV CHEMILUMINESCENCE AND VIRAL LOAD WERE REPORTED AS (B)(6). THERE IS INSUFFICIENT INFORMATION TO DETERMINE IF A MALFUNCTION OCCURRED. THE PATIENT GENDER, PREGNANCY STATUS, TREATMENT AND PATIENT OUTCOME WERE UNKNOWN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    439479 ALERE DETERMINE HIV-1/2 AG/AB COMBO IVD FOR HIV 1/2 AG/AB MZF ALERE SCARBOROUGH, INC. 103698 10811877010293

    Patients

    Seq Age Sex Outcome Treatment
    1