MAUDE Adverse Event Report: ALERE SAN DIEGO ALERE HCG COMBO CASSETTE; HCG PREGNANCY TEST

Model Number	FHC-A202
Medical Device Problem Code	False Positive Result (1227)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	04/26/2022
Type of Reportable Event	Malfunction
Event or Problem Description
The customer reported 4 false positive results when using a urine sample on the alere hcg test device (serum/urine) prior to an elective colonoscopy procedure.Confirmatory blood tests were performed with an unknown method with negative results, bhcg quant on (b)(6) 2022 was <0.2.The procedure was performed the following day.No adverse events occurred due the delay in the colonoscopy procedure.Medications: dulcolax 5 mg ec 2 days before procedure.Blisovi 24 fe 1-20 mg-mcg po qd.Golytely 1/2 sol.9pm night before procedure.Golytely 1/2 sol.6 hours before procedure.Zoloft 50 mg tab 100 mg po qd.Zoloft 100 mg tab 100 mg po qd.Multivitamin 1 tab po qd with food.Multiple vitamins/womens po 1 qd.
Additional Manufacturer Narrative
Device will not be returned.Retained devices from the reported lot number were tested with hcg-negative clinical urine samples.The results were read at 3 and 4 minutes and all devices yielded the expected negative results.No false positive results were observed during in-house testing.The case details were reviewed along with the complaint history for the reported issue and no indications of a systemic issue were identified.Manufacturing batch record review did not uncover any relevant non-conformances and found that the lot met quality control specifications.Review of the risk management report for this product found that the reported issue is within the risk profile for this device; no new hazard has been identified.A root cause could not be determined from the available information as the reported issue was not replicated during testing of retention product.Complaints are tracked and trended on a monthly basis.Per the package insert: very low levels of hcg (less than 50 miu/ml) are present in serum and urine specimens shortly after implantation.However, because a significant number of first trimester pregnancies terminate for natural reasons, a test result that is weakly positive should be confirmed by retesting with a first morning serum or urine specimen collected 48 hours later.A number of conditions other than pregnancy, including trophoblastic disease and certain non-trophoblastic neoplasms including testicular tumors, prostate cancer, breast cancer, and lung cancer, cause elevated levels of hcg.Therefore, the presence of hcg in serum or urine specimens should not be used to diagnose pregnancy unless these conditions have been ruled out.As with any assay employing mouse antibodies, the possibility exists for interference by human anti-mouse antibodies (hama) in the specimen.Specimens from patients who have received preparations of monoclonal antibodies for diagnosis or therapy may contain hama.Such specimens may cause false positive or false negative results.This test provides a presumptive diagnosis for pregnancy.A confirmed pregnancy diagnosis should only be made by a physician after all clinical and laboratory findings have been evaluated.

• Brand Name: ALERE HCG COMBO CASSETTE
• Common Device Name: HCG PREGNANCY TEST
• Manufacturer (Section D): ALERE SAN DIEGO; 9975 summers ridge rd; san diego CA 92121
• Manufacturer Contact: monika burrell ; 9975 summers ridge road; san diego, CA 92121 ; 8588052506
• MDR Report Key: 14419320
• Report Number: 2027969-2022-00012
• Device Sequence Number: 5473947
• Product Code: JHI
• UDI-Device Identifier: 10815845020123
• UDI-Public: (01)10815845020123(17)221130(10)HCG0122010
• Combination Product (Y/N): N
• Initial Reporter State: WI
• Initial Reporter Country: US
• PMA/510(K) Number: K062361
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility
• Initial Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date (Section B): 05/16/2022

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: 11/30/2022
• Device Model Number: FHC-A202
• Device Lot Number: HCG0122010
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/27/2022
• Initial Report FDA Received Date: 05/17/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: BLISOVI 24 FE 1-20 MG-MCG PO QD; DULCOLAX 5 MG EC 2 DAYS BEFORE PROCEDURE; GOLYTELY 1/2 SOL. 6 HOURS BEFORE PROCEDURE.; GOLYTELY 1/2 SOL. 9PM NIGHT BEFORE PROCEDURE; MULTIPLE VITAMINS/WOMENS PO 1 QD; MULTIVITAMIN 1 TAB PO QD WITH FOOD; ZOLOFT 100 MG TAB 100 MG PO QD.; ZOLOFT 50 MG TAB 100 MG PO QD.
• Patient Age: 39 YR
• Patient Sex: Female