MAUDE Adverse Event Report: ROCHE DIAGNOSTICS ELECSYS FT4 III; RADIOIMMUNOASSAY, FREE THYROXINE

Model Number FT4 G3

Device Problem High Test Results (2457)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 10/03/2022

Event Type  malfunction  

Manufacturer Narrative

The investigation could not identify a product problem.Assays from different vendors can generate different values.This relates to the overall setups of the assays, the antibodies used, differences in reference materials/methods, and differences in the standardization methodology used.

Event Description

The initial reporter stated they received discrepant results for two patient samples tested with elecsys tsh and the elecsys ft4 iii assay on multiple roche analyzers and compared to the abbott architect method.It is not known if any questionable results were reported outside of the laboratory.This medwatch will apply to the ft4 iii assay.Please refer to the medwatch with patient identifier (b)(6) for information related to the tsh assay.The samples were initially tested with tsh and ft4 iii on the customer's cobas e 801 module on an unknown date.The samples were provided for investigation, where they were tested with the tsh and ft4 iii assays on a second e 801 module on (b)(6) 2022.During investigations, the samples were also tested with the tsh and ft4 iii assays on a cobas e 411 analyzer.The samples were also repeated using the abbott architect tsh and ft4 methods on (b)(6) 2022.Refer to the attachment for all relevant test data.The serial number of the customer's e 801 analyzer was requested but not provided.The serial number of the e 801 analyzer used for investigation is (b)(4).Ft4 iii reagent lot 630888, with an expiration date of 31-may-2023 was used on this analyzer the serial number of the e411 analyzer used for investigation is (b)(4).Ft4 iii reagent lot 593219, with an expiration date of 31-dec-2022was used on this analyzer.

• Brand Name: ELECSYS FT4 III
• Type of Device: RADIOIMMUNOASSAY, FREE THYROXINE
• Manufacturer (Section D): ROCHE DIAGNOSTICS; 9115 hague road; indianapolis IN 46250 0457
• Manufacturer (Section G): ROCHE DIAGNOSTICS GMBH; sandhoferstrasse 116; na; mannheim (baden-wurttemberg) 68305 ; GM 68305
• Manufacturer Contact: amy nelson ; 9115 hague road; na; indianapolis, IN 46250 ; 3174767531
• MDR Report Key: 15737571
• MDR Text Key: 307166595
• Report Number: 1823260-2022-03499
• Device Sequence Number: 1
• Product Code: CEC
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K131244
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional,User Facility
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 11/04/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 05/31/2023
• Device Model Number: FT4 G3
• Device Catalogue Number: 07976836190
• Device Lot Number: 630888, 593219
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 10/12/2022
• Initial Date FDA Received: 11/04/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1