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

Model Number FT4 G3

Device Problem Low Test Results (2458)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 03/16/2020

Event Type  malfunction  

Manufacturer Narrative

This event occurred in (b)(6).(b)(4).

Event Description

The initial reporter received questionable elecsys ft4 iii assay results for one patient from the cobas 8000 e 801 module, serial number (b)(4).The customer reported out the results to a physician who asked for re-measurement of the sample.Sample from the patient was submitted for investigation and was tested on a centaur analyzer, cobas e 411 immunoassay analyzer, e 801 module, and a cobas 8000 e 602 module.Refer to the attachment to the medwatch for all patient data.This medwatch is for ft4.Refer to the medwatch with patient identifier (b)(6) for the tsh assay, and patient identifier (b)(6) for the ft3 assay.

Manufacturer Narrative

The patient's sample was provided for investigation.The investigation determined the results generated at the customer site were confirmed.An interfering factor against a component of the reagent was not identified.The investigation did not identify a product problem.The cause of the event could not be determined.

• Brand Name: ELECSYS FT4 III ASSAY
• Type of Device: RADIOIMMUNOASSAY, FREE THYROXINE
• Manufacturer (Section D): ROCHE DIAGNOSTICS; 9115 hague road; indianapolis IN 46250 0457
• MDR Report Key: 9932774
• MDR Text Key: 186704703
• Report Number: 1823260-2020-00979
• Device Sequence Number: 1
• Product Code: CEC
• Combination Product (y/n): N
• PMA/PMN Number: K131244
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,health professional,u
• Type of Report: Initial,Followup
• Report Date: 06/26/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/07/2020
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: FT4 G3
• Device Catalogue Number: 07976887190
• Device Lot Number: ASKU
• Was Device Available for Evaluation?: Yes
• Date Manufacturer Received: 03/17/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1