MAUDE Adverse Event Report: ABBOTT DIAGNOSTICS SCARBOROUGH, INC. BINAXNOW COVID-19 AG SELF TEST 4CT; CORONAVIRUS ANTIGEN DETECTION TEST SYSTEM.

Catalog Number	195-180
Medical Device Problem Code	False Positive Result (1227)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/29/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The remainder of the investigation remains in progress.A supplemental report will be provided after completion or upon receipt of new information.
Event or Problem Description
The consumer reported a false positive result with the binaxnow covid-19 antigen self-test performed on (b)(6) 2024 on a nasal sample.The consumer performed prior testing with the binaxnow self-test on (b)(6) 2024 and an unknown date and both tests generated negative results.The consumer performed additional testing with an ihealth covid test on (b)(6) 2024 and generated a negative result.On (b)(6) 2024, the consumer already had symptoms like fever, sore throat, and head congestion.The consumer contacted his doctor but was not provided medication.On (b)(6) 2024, the consumer was experiencing symptoms of head congestion and achy body.The consumer confirmed there was no patient harm due to the test results.Additionally, the consumer confirmed there was no delay or impact in their treatment.
Additional Manufacturer Narrative
Testing was performed at abbott diagnostics scarborough, inc.On retained kit lot 870976a with internal positive quality control samples and negative quality control swabs.All test results were valid and performed as expected.Additionally, the manufacturing records and quality control release testing was reviewed for test kit part number 195-180/ lot 870976a and test base part number 195-430wjr/ lot 870976.The lot met the required release specifications.A review of the complaints reported false positive patient results (confirmed and unconfirmed, conflicting results) related to kit lot 870976a showed that the complaint rate is (b)(4).Abbott diagnostics scarborough was unable to determine the exact root cause of the reported issue, however, it could have possibly been related to the specific patient sample.
Event or Problem Description
The consumer reported a false positive result with the binaxnow covid-19 antigen self-test performed on (b)(6) 2024 on a nasal sample.The consumer performed prior testing with the binaxnow self-test on (b)(6) 2024 and an unknown date and both tests generated negative results.The consumer performed additional testing with an ihealth covid test on (b)(6) 2024 and generated a negative result.On (b)(6) 2024, the consumer already had symptoms like fever, sore throat, and head congestion.The consumer contacted his doctor but was not provided medication.On (b)(6) 2024, the consumer was experiencing symptoms of head congestion and achy body.The consumer confirmed there was no patient harm due to the test results.Additionally, the consumer confirmed there was no delay or impact in their treatment.

• Brand Name: BINAXNOW COVID-19 AG SELF TEST 4CT
• Common Device Name: CORONAVIRUS ANTIGEN DETECTION TEST SYSTEM.
• Manufacturer (Section D): ABBOTT DIAGNOSTICS SCARBOROUGH, INC.; 10 southgate road; scarborough ME 04074
• Manufacturer Contact: rachel blackwell ; 10 southgate road; scarborough, ME 04074 ; 6613888803
• MDR Report Key: 19905517
• Report Number: 1221359-2024-00528
• Device Sequence Number: 8752410
• Product Code: QKP
• UDI-Device Identifier: 00811877011729
• UDI-Public: 01008118770117291726011210870976A
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: EUA210264
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 09/25/2024

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: Lay User/Patient
• Device Expiration Date: 01/12/2026
• Device Catalogue Number: 195-180
• Device Lot Number: 870976A
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/29/2024
• Supplement Date Received by Manufacturer: 09/23/2024
• Initial Report FDA Received Date: 08/05/2024
• Supplement Report FDA Received Date: 09/25/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 05/21/2024
• 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: 57 YR
• Patient Sex: Male
• Patient Weight: 93 KG
• Patient Ethnicity: Hispanic
• Patient Race: White