MAUDE Adverse Event Report: ABBOTT POINT OF CARE I-STAT CG4+ CARTRIDGE

Catalog Number 03P85-25

Device Problem Incorrect, Inadequate or Imprecise Result or Readings (1535)

Patient Problem No Information (3190)

Event Date 08/31/2019

Event Type  malfunction  

Manufacturer Narrative

Apoc incident (b)(4).Apoc labeling will be evaluated during the investigation as pertaining to the event.

Event Description

On (b)(6) 2019, abbott point of care was contacted by a customer regarding i-stat cg4+ cartridges that yielded a suspected discrepant lactate result of 4.91 on a patient.There was no patient information available at the time of this report.Method: i-stat, date: 08/31/2019, result: 4.91 mmol/l.I-stat, 08/31/2019, 1.85 mmol/l.There are no injuries associated with this event.At this time there is no reason to suspect a malfunction exists.The reporting decision was based on limited information available that suggests the product was not performing within the variability of the assay.The investigation is underway.

Event Description

Na.

Manufacturer Narrative

Apoc incident #: (b)(4).The investigation was completed on 09/24/2019.A review of the device history record confirmed the lot passed finished goods release criteria.Retained cartridge testing met the acceptance criteria found in q04.01.003 rev.Ad, appendix 1- product complaint level 2 and level 3 investigation procedure.No deficiency has been identified.

Manufacturer Narrative

Apoc incident # (b)(4).The investigation was completed on 09/24/2019.New information was received on 09/17/2019 but was not included in the supplemental report.See a2, a3, b5, b6 and b7.

Event Description

Method date time collected time tested lactate result sample type and identifier i-stat (b)(6) 2019 09.30 09.34 4.91 mmol/l a i-stat (b)(6) 2019.10.36am 10.41am 1.85 mmol/l b.

• Brand Name: I-STAT CG4+ CARTRIDGE
• Type of Device: CG4+ CARTRIDGE
• Manufacturer (Section D): ABBOTT POINT OF CARE; 400 college road; princeton NJ 08540 6607
• MDR Report Key: 9077673
• MDR Text Key: 195934090
• Report Number: 2245578-2019-00225
• Device Sequence Number: 1
• Product Code: KHP
• UDI-Device Identifier: 10054749000132
• UDI-Public: 10054749000132
• Combination Product (y/n): N
• PMA/PMN Number: K982071
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional
• Type of Report: Initial,Followup,Followup
• Report Date: 10/02/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/17/2019
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 09/16/2019
• Device Catalogue Number: 03P85-25
• Device Lot Number: M19017
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 09/17/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Age: 89 YR