MAUDE Adverse Event Report: ABBOTT IRELAND DIAGNOSTICS DIVISION ARCHITECT FREE T4 REAGENT KIT; RADIOIMMUNOASSAY, FREE THYROXINE

Catalog Number	07K65-34
Medical Device Problem Code	High Test Results (2457)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/04/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Section a1 - patient identifier: complete sid is (b)(6).An evaluation is in process.A follow-up report will be submitted when the evaluation is complete.
Event or Problem Description
The customer observed falsely elevated architect free t4 result generated on the architect i2000sr processing module for a patient with congestive cardiac failure and sick sinus syndrome.The samples were repeated and lower results were obtained.The following data was provided: customer¿s normal range: 0.70 to 1.48 ng/dl sid(b)(6): (b)(6) 2024 sample 1 (serum): initial result = >5.0 ng/dl; repeat result = 1.50 ng/dl repeat result on another instrument ((b)(6)) = 1.97 ng/dl (b)(6) 2024 repeat result after recentrifuged = 1.0 ng/dl other test result provided: tsh = 2.949 ¿iu/ml (b)(6) 2024 sample 2 (serum): initial result = 2.88 ng/dl repeat result on another instrument ((b)(6)) = 1.96 ng/dl repeat result after recentrifuged = 1.16 ng/dl (b)(6) 2024 sample 3 (plasma): initial result = 1.09 ng/dl repeat result on another instrument ((b)(6)) = 1.01 ng/dl the customer provided the patient¿s medication which included the following: aspara potassium tablets, ensure, mohrus tapes, lixiana (fxa inhibitor, anticoagulant) there was no impact to patient management reported.
Event or Problem Description
The customer observed falsely elevated architect free t4 result generated on the architect i2000sr processing module for a patient with congestive cardiac failure and sick sinus syndrome.The samples were repeated and lower results were obtained.The following data was provided: customer¿s normal range: 0.70 to 1.48 ng/dl (b)(6): (b)(6) 2024 sample 1 (serum): initial result = >5.0 ng/dl; repeat result = 1.50 ng/dl repeat result on another instrument ((b)(6)) = 1.97 ng/dl (b)(6) 2024 repeat result after recentrifuged = 1.0 ng/dl.Other test result provided: tsh = 2.949 iu/ml.(b)(6) 2024 sample 2 (serum): initial result = 2.88 ng/dl.Repeat result on another instrument ((b)(6)) = 1.96 ng/dl.Repeat result after recentrifuged = 1.16 ng/dl.(b)(6) 2024 sample 3 (plasma): initial result = 1.09 ng/dl.Repeat result on another instrument ((b)(6)) = 1.01 ng/dl.The customer provided the patient¿s medication which included the following: aspara potassium tablets, ensure, mohrus tapes, lixiana (fxa inhibitor, anticoagulant) there was no impact to patient management reported.
Additional Manufacturer Narrative
Section d4 - primary udi number: this section was corrected from (b)(4).The complaint investigation for falsely elevated architect free t4 results included a review of data and information provided by the customer, ticket trending review, device history record review, and labeling review.In addition, in-house testing of retained reagent kit was also completed.Return testing was not completed as returns were not available.The data and information provided by the customer were reviewed and support the complaint issue.A review of the complaint trending report did identify an increase in complaints for lot 56001ud00, however, in-house performance testing was completed which indicates the product is performing as expected.A review of the device history record did not identify any non-conformances or deviations with lot number 56001ud00 and the complaint issue.A review of labeling was performed and found to sufficiently address the customer's issue.Based on this investigation, no systemic issue or deficiency was identified with the architect free t4 reagent, lot number 56001ud00.

• Brand Name: ARCHITECT FREE T4 REAGENT KIT
• Common Device Name: RADIOIMMUNOASSAY, FREE THYROXINE
• Manufacturer (Section D): ABBOTT IRELAND DIAGNOSTICS DIVISION; lisnamuck; co. longford; longford N39E9 32; EI N39E932
• Manufacturer (Section G): ABBOTT IRELAND DIAGNOSTICS DIVISION; lisnamuck; co. longford; longford N39E9 32; EI N39E932
• Manufacturer Contact: nicole jenne ; max-planck-ring 2; post market surveillance; wiesbaden 65205 ; GM 65205 ; 6122582960
• MDR Report Key: 18927395
• Report Number: 3005094123-2024-00129
• Device Sequence Number: 4513204
• Product Code: CEC
• UDI-Device Identifier: 00380740119805
• UDI-Public: (01)00380740119805(17)240926(10)56001UD00
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K173122
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 05/01/2024

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 Expiration Date: 09/26/2024
• Device Catalogue Number: 07K65-34
• Device Lot Number: 56001UD00
• 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: 03/04/2024
• Supplement Date Received by Manufacturer: 04/24/2024
• Initial Report FDA Received Date: 03/18/2024
• Supplement Report FDA Received Date: 05/01/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 10/19/2023
• 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: ARC I2K PROC MOD, 03M74-01, (B)(6) ; ARC I2K PROC MOD, 03M74-01, (B)(6)
• Patient Sex: Unknown