MAUDE Adverse Event Report: PROGENIKA BIOPHARMA S.A. ID CORE XT

Model Number 1291720000

Device Problem False Positive Result (1227)

Patient Problem Patient Problem/Medical Problem (2688)

Event Date 06/03/2020

Event Type  malfunction  

Manufacturer Narrative

The genomic dna sample was sent to grifols ih center for dna sequencing.Sequencing interrogated specific sequences: gypb gene exons 1-2; exons 4-6 and pseudo-exon 3 and the variant gypb:c.101c>t was identified.This variant is not currently described in the literature.Although its effect is unknown, the most probable location of this variant is on the allele gypb*s, based on the serology results, s -.Id core xt reported a predicted s+ phenotype, but the serology data from the user is s-, due to the variant gypb:c.101c>t.This false positive result obtained by id core xt is considered a discrepant result and then a malfunction.This limitation is covered by the general assay limitation described in the id core xt package insert (limitation 1 and 10).

Event Description

The customer reported a possible discrepancy.The serological phenotype was s negative and the id core xt genotype suggested a phenotype of s positive.

• Brand Name: ID CORE XT
• Type of Device: ID CORE XT
• Manufacturer (Section D): PROGENIKA BIOPHARMA S.A.; ibaizabal bidea, edificio 504; parque tecnológico de bizkaia; derio, bizkaia 48160 ; SP 48160
• Manufacturer (Section G): PROGENIKA BIOPHARMA S.A.; ibaizabal bidea, edificio 504; parque tecnológico de bizkaia; derio, bizkaia 48160 ; SP 48160
• Manufacturer Contact: diego tejedor ; ibaizabal bidea, edificio 504; parque tecnológico de bizkaia; derio, bizkaia 48160 ; SP 48160
• MDR Report Key: 10243018
• MDR Text Key: 219199617
• Report Number: 3006413195-2020-00009
• Device Sequence Number: 1
• Product Code: PEP
• UDI-Device Identifier: 08437013457019
• UDI-Public: (01)08437013457019(17)081020(10)0203000019
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: BP170154
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor,user facility
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 07/08/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/07/2020
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Expiration Date: 08/10/2020
• Device Model Number: 1291720000
• Device Catalogue Number: 1021720000
• Device Lot Number: 0203000019
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 06/05/2020
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 05/14/2019
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: Yes
• Type of Device Usage: N
• Removal/Correction Number: N/A
• Patient Sequence Number: 1