MAUDE Adverse Event Report: A.I.D.D LONGFORD ALINITY I TOTAL B-HCG REAGENT KIT; SYSTEM, TEST, HUMAN CHORIONIC GONADOTROPIN

Model Number	07P5121
Medical Device Problem Code	False Positive Result (1227)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/23/2022
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
An evaluation is in process.A follow up report will be submitted when the evaluation is complete.Patient identifier sids: (b)(6).
Event or Problem Description
The customer reported a false positive alinity i total b-hcg result on a (b)(6) female patient.Results provided: (b)(6) 2022 sid (b)(6) = (b)(6) miu/ml, repeated on another alinity at this site = (b)(6) miu/ml, beckman dxl = < 0.2, alere hcg combo is negative; heterophilic ab testing is negative.This patient has been positive with the alinity i total b-hcg in the past, results provided: results from sn# (b)(4).Sid (b)(6) ; value (b)(6); date ((b)(6) 2022).Sid (b)(6) ; value (b)(6); date ((b)(6) 2022).Sid (b)(6) ; value (b)(6); date ((b)(6) 2022).Sid (b)(6) ; value (b)(6); date ((b)(6 )2022).Sid (b)(6) ; value (b)(6); date ((b)(6) 2022).Sid (b)(6) ; value (b)(6); date ((b)(6) 2022).Another hospital = (b)(6); (another lab: beckman dxi < 2.0 ).Results from sn# (b)(4).Sid (b)(6) ; value (b)(6); date ((b)(6)2022).Sid (b)(6) ; value (b)(6); date ((b)(6) 2022).Sid (b)(6) ; value (b)(6); date ((b)(6) 2022).The patient had an ultrasound performed without iv contrast due to the positive alinity result which showed nothing.No impact to patient management was reported.
Additional Manufacturer Narrative
Return testing was not completed as returns were not available.Manufacturing documentation for the likely cause lot did not identify any issues associated with the complaint issue.The ticket search determined that there is normal complaint activity.There are no trends for the product related to patient results.The overall performance of alinity i total ss-hcg reagents in the field was reviewed using data gathered via abbottlink from customers worldwide.The number of standard deviations to the cut-off and the median of the negative populations is within the established limits and within the historical range of the alinity i total ss-hcg assay.Additionally, accuracy of the alinity i total ss-hcg assay has been evaluated with a retained in-house kit of the same lot# 32500ud00 and met all specifications, confirming that this lot is meeting the alinity i total ss-hcg product requirements.A review of the product labeling concluded that the issue is sufficiently addressed.Based on the investigation no systemic issue or product deficiency was identified for the alinity i total ss-hcg lot# 32500ud00.

• Brand Name: ALINITY I TOTAL B-HCG REAGENT KIT
• Common Device Name: SYSTEM, TEST, HUMAN CHORIONIC GONADOTROPIN
• Manufacturer (Section D): A.I.D.D LONGFORD; lisnamuck; co. longford; longford N39E9 32; EI N39E932
• Manufacturer (Section G): A.I.D.D LONGFORD; lisnamuck; co. longford; longford N39E9 32; EI N39E932
• Manufacturer Contact: siobhan wright ; lisnamuck; post market surveillance; longford N39 E-932 ; EI N39 E932 ; 433331157
• MDR Report Key: 13712364
• Report Number: 3005094123-2022-00041
• Device Sequence Number: 17713965
• Product Code: DHA
• UDI-Device Identifier: 00380740160616
• UDI-Public: 00380740160616
• Combination Product (Y/N): N
• Initial Reporter State: RI
• Initial Reporter Country: US
• PMA/510(K) Number: K170317
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 04/25/2022

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: 09/08/2022
• Device Model Number: 07P5121
• Device Catalogue Number: 07P51-21
• Device Lot Number: 32500UD00
• 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: 02/24/2022
• Supplement Date Received by Manufacturer: 04/22/2022
• Initial Report FDA Received Date: 03/09/2022
• Supplement Report FDA Received Date: 04/25/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/08/2021
• 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
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: ALNTY I PROCESSING MODU, 03R65-01, (B)(4).; ALNTY I PROCESSING MODU, 03R65-01, (B)(4).; ALNTY I PROCESSING MODU, 03R65-01, (B)(4).; ALNTY I PROCESSING MODU, 03R65-01, (B)(4).
• Patient Age: 37 YR
• Patient Sex: Female