MAUDE Adverse Event Report: SIEMENS HEALTHCARE DIAGNOSTICS INC DIMENSION VISTA®; DIMENSION VISTA® TNIH HIGH-SENSITIVITY TROPONIN I FLEX® REAGENT CARTRIDGE

Model Number	10471067
Medical Device Problem Code	High Test Results (2457)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/14/2021
Type of Reportable Event	Malfunction
Event or Problem Description
A discordant falsely elevated high-sensitivity troponin i (tnih) patient sample result was obtained on a dimension vista 500 system.The discordant result was reported to the physician(s).The same sample was reprocessed after removal of correlation factors for the tnih assay.A lower result was obtained.There are no known reports of patient intervention or adverse health consequences due to the discordant falsely elevated patient tnih result.
Additional Manufacturer Narrative
A united states customer contacted the siemens healthcare diagnostics customer care center (ccc) regarding a discordant falsely elevated high-sensitivity troponin i (tnih) patient sample result obtained on a dimension vista 500 system.Siemens is investigating the event.
Additional Manufacturer Narrative
Additional information (21-nov-2021): siemens healthcare diagnostics headquarters support center (hsc) concluded the investigation of the event.Hsc reviewed the instrument data log and the information provided by the customer.Hsc concluded that the event was an operator use error.The dimension vista high sensitivity troponin i (tnih) assay lot 21209ba does not require the use of lot specific correlation factors.The cause of the event was that the customer was operating with tnih lot specific correlation factors entered for a tnih assay lot that did not require lot specific correlation factors.Removal of the incorrect tnih assay correlation factors resolved the issue.The device is performing within specifications.No further evaluation is required.Section h6 has been updated to reflect the hsc investigation initial mdr 2517506-2021-00308 was filed 16-nov-2021.

• Brand Name: DIMENSION VISTA®
• Common Device Name: DIMENSION VISTA® TNIH HIGH-SENSITIVITY TROPONIN I FLEX® REAGENT CARTRIDGE
• Manufacturer (Section D): SIEMENS HEALTHCARE DIAGNOSTICS INC; 500 gbc drive; po box 6101; newark DE 19714 6101
• Manufacturer (Section G): SIEMENS HEALTHCARE DIAGNOSTICS INC.; 500 gbc drive; po box 6101; newark DE 19714 6101
• Manufacturer Contact: james morgera ; 500 gbc drive; po box 6101; newark, DE 19714-6101
• MDR Report Key: 12820209
• Report Number: 2517506-2021-00308
• Device Sequence Number: 20030543
• Product Code: MMI
• UDI-Device Identifier: 00842768037719
• UDI-Public: 00842768037719
• Combination Product (Y/N): N
• Initial Reporter State: AL
• Initial Reporter Country: US
• PMA/510(K) Number: K182225
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 12/03/2021

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
• Operator of Device: Health Professional
• Device Expiration Date: 05/24/2022
• Device Model Number: 10471067
• Device Catalogue Number: K6427 SMN 10471067
• Device Lot Number: 21209BA
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 10/22/2021
• Supplement Date Received by Manufacturer: 11/21/2021
• Initial Report FDA Received Date: 11/16/2021
• Supplement Report FDA Received Date: 12/03/2021
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 07/28/2021
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown