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U.S. Department of Health and Human Services

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

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ROCHE DIAGNOSTICS ELECSYS FT4 ASSAY; RADIOIMMUNOASSAY, FREE THYROXINE Back to Search Results
Catalog Number ASKU
Device Problem Low Test Results (2458)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Date 01/09/2018
Event Type  malfunction  
Manufacturer Narrative
This event occurred in (b)(6).
 
Event Description
The customer questioned results from 5 patient samples tested for elecsys tsh (tsh), elecsys ft3 iii (ft3 iii) and elecsys ft4 (ft4) on a cobas e801 module.The customer provided the 5 patient samples for investigation.Of the data provided, erroneous tsh results were identified for 4 patient samples and erroneous ft3 iii and ft4 results were identified for 1 patient sample when tested on the customer's e 801 analyzer, a siemens centaur analyzer, an e801 module used at the investigation site, a cobas 8000 e 602 module used at the investigation site and a cobas e 411 immunoassay analyzer used at the investigation site.It is not known if the initial results from the customer site were reported outside of the laboratory.This medwatch will cover ft4.Refer to medwatch with a1 patient identifier (b)(6) for information on the ft3 iii erroneous results and medwatch with a1 patient identifier (b)(6) for information on the tsh erroneous results.Refer the attached data for the patient results.There was no allegation that an adverse event occurred.The serial number for the customer's e801 module was not provided.The e602 module serial number was (b)(4).The e411 analyzer serial number was (b)(4).The e801 module serial number used at the investigation site was (b)(4).The elecsys ft4 ii assay (ft4 ii) reagent lot number used with the e602 module was 265631 with an expiration date of (b)(6) 2018.The ft4 ii reagent lot number used with the e411 analyzer was 270341 with an expiration date of (b)(6) 2018.The ft4 ii reagent lot number used with the e801 module at the investigation site was (b)(6) with an expiration date of (b)(6) 2018.Patient sample id (b)(6) was submitted for investigation.The ft3 iii results were higher than the reference range.The ft4 ii and tsh results were within the reference range.Based on the investigation performed, an interfering factor to the assay was not identified.
 
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Brand Name
ELECSYS FT4 ASSAY
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
michael leslie
9115 hague road
na
indianapolis, IN 46250
3175214343
MDR Report Key7269257
MDR Text Key100272595
Report Number1823260-2018-00423
Device Sequence Number1
Product Code CEC
Combination Product (y/n)N
Reporter Country CodeJA
PMA/PMN Number
ASKU
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type foreign,health professional,u
Reporter Occupation Health Professional
Type of Report Initial
Report Date 02/14/2018
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received02/14/2018
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Catalogue NumberASKU
Device Lot NumberASKU
Was Device Available for Evaluation? Yes
Is the Reporter a Health Professional? Yes
Date Manufacturer Received01/29/2018
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
Type of Device Usage N
Patient Sequence Number1
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