MAUDE Adverse Event Report: ABBOTT POINT OF CARE I-STAT CG8+ CARTRIDGE

Catalog Number	03P88-25
Medical Device Problem Code	Incorrect, Inadequate or Imprecise Result or Readings (1535)
Health Effect - Clinical Code	Respiratory Insufficiency (4462)
Date of Event	07/10/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Apoc incident # 926294.Apoc labeling will be evaluated during the investigation as pertaining to the event.
Event or Problem Description
On (b)(6) 2023, abbott point of care was contacted by a customer regarding i-stat cg8+ cartridges that yielded a suspected discrepant hematocrit result on a 67 year old male patient subjectively feeling lightheaded with shortness of breath.There was no patient additonal information at the time of this report.Return product is available for investigation.Method date tested hct(%) sample i-stat 10-july 23:56 42 a sysmex 10-july 00:15 21.1 a collection times not provided.Per the facility: the act was called to bedside for vitals: hypotension 70/40s, tachy 140s.Patient subjectively feeling lightheaded with shortness of breath.The patient has recent history of aortoenteric fistula s/p graft.1l fulids ongoing, x1 100cc neo, levo started, addition x1 100cc neo.Poc hgb 6.6, lactate 4.0, prbc ordered, concerning for right lower quadrant tenderness.Ordered emergency ct, showing prp opacity concerning for bleed.Patient was transferred to sicu.The customer reported that the patient was pronounced dead at 14:00 on (b)(6) 2023.The cause of death was hemorrhagic shock.At this time there is no reason to suspect a malfunction exists.There is no reason to believe the i-stat caused or contributed to the patient's demise.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.
Additional Manufacturer Narrative
Apoc incident: # (b)(4).The investigation was completed on 21-aug-2023.A review of the device history record (dhr) confirmed the lot passed finished goods release criteria.Retained and returned cartridge testing met the acceptance criteria found in q04.01.003 rev.Al, appendix 1 - product complaint level 2 and level 3 investigation procedure.No deficiency has been identified.

• Brand Name: I-STAT CG8+ CARTRIDGE
• Common Device Name: CG8+ CARTRIDGE
• Manufacturer (Section D): ABBOTT POINT OF CARE; 400 college road; princeton NJ 08540 6607
• Manufacturer (Section G): ABBOTT POINT OF CARE CANADA LTD.; 185 corkstown road; K2H 8 V4; CA K2H 8V4
• Manufacturer Contact: linda maczuszenko ; 185 corkstown road; princeton, nj K2H 8-V4 ; CA K2H 8V4
• MDR Report Key: 17390823
• Report Number: 2245578-2023-00095
• Device Sequence Number: 6780068
• Product Code: CHL
• UDI-Device Identifier: 10054749000163
• UDI-Public: 10054749000163
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• PMA/510(K) Number: K940918
• 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): 08/30/2023

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: 11/19/2023
• Device Catalogue Number: 03P88-25
• Device Lot Number: W23081A
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 07/20/2023
• Supplement Date Received by Manufacturer: 08/21/2023
• Initial Report FDA Received Date: 07/25/2023
• Supplement Report FDA Received Date: 08/30/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 03/22/2023
• 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
• Patient Age: 67 YR
• Patient Sex: Male