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

Catalog Number 07976836190

Device Problem High Test Results (2457)

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

Event Date 08/22/2023

Event Type  malfunction  

Manufacturer Narrative

The serial number of the customer's cobas 6000 e601 module is (b)(6).The patient sample collected on (b)(6) 2023 was received for investigation.The investigation performed an initial test to check for interference.The investigation did not find any significant changes for the tsh, ft4 iii, t4 v2, and t4 v3 assays.There were also no significant t4 concentration differences between testing with the different versions of the t4 assays.The investigation is ongoing.

Event Description

The initial reporter received questionable elecsys t4 (t4) and elecsys ft4 (ft4) results from two samples from the same patient tested on the cobas 6000 e601 module.This medwatch is for the ft4 assay.Please refer to the medwatch with a1.Patient identifier (b)(6) for the t4 assay.The initial results were reported outside of the laboratory.The doctor questioned the results as they did not match the patient's clinical diagnosis.The reporter then sent the patient samples to another laboratory that uses beckman, abbott, and siemens centaur analyzers.The reporter stated that they think that the results from the abbott analyzer matched the patient's clinical diagnosis.The reporter wants to know if there was an interference with the roche assays, please refer to the attachment (b)(6) in the medwatch for the highlighted questionable results.

Manufacturer Narrative

Medwatch fields d4 catalog no, d4 udi and g4 pma / 510k (premarket numbers) were updated.The patient sample was further tested using a heterophilic blocking tube (hbt) treatment; no significant changes were found for the ft4 iii and t4 results.No interfering factors were identified.The cause of the event could not be determined.Product labeling states "for diagnostic purposes, the results should always be assessed in conjunction with the patient¿s medical history, clinical examination and other findings.".

• 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; sandhofer strasse 116; mannheim (baden-wurttemberg) 68305 ; GM 68305
• Manufacturer Contact: amy nelson ; 9115 hague road; indianapolis, IN 46250-0457
• MDR Report Key: 17816454
• MDR Text Key: 324233127
• Report Number: 1823260-2023-03090
• Device Sequence Number: 1
• Product Code: CEC
• Combination Product (y/n): Y
• Reporter Country Code: CH
• 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,Followup
• Report Date: 11/17/2023

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 Catalogue Number: 07976836190
• Device Lot Number: 67527903
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 08/28/2023
• Initial Date FDA Received: 09/26/2023
• Supplement Dates Manufacturer Received: 10/25/2023
• Supplement Dates FDA Received: 11/17/2023
• 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
• Patient Age: 51 YR
• Patient Sex: Female