MAUDE Adverse Event Report: SIEMENS HEALTHCARE DIAGNOSTICS INC. ATELLICA IM CARCINOEMBRYONIC ANTIGEN (CEA); SYSTEM, TEST, CARCINOEMBRYONIC ANTIGEN

Model Number	N/A
Medical Device Problem Code	High Test Results (2457)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/03/2024
Type of Reportable Event	Malfunction
Event or Problem Description
The customer reports observation of elevated atellica im carcinoembryonic antigen (cea) results which were discordant relative to repeat testing.Cea lot 218 was in use at the time.Elevated results were observed for 18 patients.The results were very high, and were not reported to physicians.The same samples were repeat-tested using another reagent pack from the same lot, and all of the results were much lower.These lower results were consistent with clinical expectation, and reported to physicians.There are no known reports of patient intervention or adverse health consequences due to the discordant elevated cea results.
Additional Manufacturer Narrative
A customer from outside the united states reported observation of discordant elevated carcinoembryonic antigen (cea) results for eighteen patient samples which were discordant relative to repeat testing.There were no visible issues (clumps, precipitate) with the reagent pack which produced the discordant results.No pack calibration was performed using this pack.It was noted that one level of the bio-rad quality control (qc) samples tested using this pack had been above expected range.No instrument errors were observed.Siemens is evaluating the event.
Additional Manufacturer Narrative
Mdr 1219913-2024-00309 was initially filed on 16-may-2024.Additional information (18-jun-2024): siemens healthcare diagnostics has concluded the investigation of the event.Siemens evaluated the instrument data and the information provided by the customer.No instrument errors were observed during this event.The reagent used for testing were assessed and no abnormalities were observed.Reagent and instrument issues were ruled out based on quality control (qc) recovery within acceptable ranges, instrument data, and no issues were reported with other patient samples.Based on the available information, the cause of the discordant results was unable to be determined.A product problem was not identified.In section h6, the investigation findings and investigation conclusions codes were updated.

• Brand Name: ATELLICA IM CARCINOEMBRYONIC ANTIGEN (CEA)
• Common Device Name: SYSTEM, TEST, CARCINOEMBRYONIC ANTIGEN
• Manufacturer (Section D): SIEMENS HEALTHCARE DIAGNOSTICS INC.; 511 benedict ave; tarrytown NY 10591
• Manufacturer (Section G): SIEMENS HEALTHCARE DIAGNOSTICS INC; 333 coney st.; registration# 1219913; east walpole MA 02032
• Manufacturer Contact: barry memishian ; 333 coney st.; east walpole, MA 02032 ; 5082985306
• MDR Report Key: 19333287
• Report Number: 1219913-2024-00309
• Device Sequence Number: 3101959
• Product Code: DHX
• UDI-Device Identifier: 00630414598512
• UDI-Public: 00630414598512
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K200215
• 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): 07/03/2024

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: 08/21/2024
• Device Model Number: N/A
• Device Catalogue Number: 10995524
• Device Lot Number: 218
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 05/06/2024
• Supplement Date Received by Manufacturer: 06/18/2024
• Initial Report FDA Received Date: 05/16/2024
• Supplement Report FDA Received Date: 07/03/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 08/21/2023
• 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
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown