MAUDE Adverse Event Report: ROCHE DIAGNOSTICS COBAS 8000 ISE 1800 MODULE; CLINICAL CHEMISTRY ANALYZER

Catalog Number	05964075001
Medical Device Problem Codes	Suction Problem (2170); Non Reproducible Results (4029)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/02/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The electrode lot number and expiration date were not provided.It was noted the customer experienced a problem in the water system.The field service representative decontaminated the module, but the issue was not resolved.The investigation is ongoing.
Event or Problem Description
There was an allegation of questionable na+ results for "several" patient samples on a cobas 8000 ise 1800 module.An example of discrepant results was provided for 1 patient sample.The initial result was 132.44 mmol/l.The sample was repeated due to the result not matching the clinical picture of the patient.The repeated result was 138.35 mmol/l.The repeated result was believed to be correct.The questionable result was not reported outside of the laboratory.
Additional Manufacturer Narrative
The field service representative replaced the electrodes, sample probe, vacuum nozzle, dilution nozzle, vacuum tube, sipper nozzle, tubes from nozzle dilution, and solenoids from the sipper and the vacuum.He adjusted the sample probe, nozzle dilution, and gear pump.Based on the available data, it was not possible to determine the detailed root cause of the reported discrepancy.After service, no issues were reported by the customer.The investigation determined the service actions resolved the issue.

• Brand Name: COBAS 8000 ISE 1800 MODULE
• Common Device Name: CLINICAL CHEMISTRY ANALYZER
• Manufacturer (Section D): ROCHE DIAGNOSTICS; 9115 hague road; indianapolis IN 46250 0457
• Manufacturer (Section G): HITACHI HIGH TECH CORP.; 882 ichige hitachinaka; ibaraki 312-8 504; JA 312-8504
• Manufacturer Contact: amy nelson ; 9115 hague road; indianapolis, IN 46250
• MDR Report Key: 18803307
• Report Number: 1823260-2024-00585
• Device Sequence Number: 15261639
• Product Code: JJE
• UDI-Device Identifier: 04015630946341
• UDI-Public: 04015630946341
• Combination Product (Y/N): Y
• Initial Reporter Country: SP
• PMA/510(K) Number: K100853
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/21/2024

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 Catalogue Number: 05964075001
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 02/02/2024
• Supplement Date Received by Manufacturer: 05/27/2024
• Initial Report FDA Received Date: 02/28/2024
• Supplement Report FDA Received Date: 06/21/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• 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
• Patient Sex: Unknown