MAUDE Adverse Event Report: ABBOTT GMBH ALINITY C TOTAL BILIRUBIN REAGENT KIT; DIAZO COLORIMETRY, BILIRUBIN

Catalog Number	04V51-31
Medical Device Problem Code	Low Test Results (2458)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/09/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Complete entry for section a1 - patient identifier: (b)(6).An evaluation is in process.A follow-up report will be submitted when the evaluation is complete.All available patient information was included.Additional patient details are not available.
Event or Problem Description
The customer observed a falsely depressed total bilirubin2 on the alinity c processing module for one male patient.The following results were provided (reference range < 20 umol/l): sid (b)(6),.On (b)(6) 2024, the first run of the sample generated an error code of 1041, reaction check failure on the alinity sn (b)(6); when repeated the initial bilirubin result= 2 umol/l.Repeat testing on the alinity sn (b)(6) generated the error code 1041 again; when repeated, after recentrifugation, results= 200.1 umol/l and 196.2 umol/l.Additional results were provided for historical/ additional comparison: on (b)(6) 2024= 204 umol/l.On (b)(6) 2024= 209 umol/l.On (b)(6) 2024= 218 umol/l.On (b)(6) 2024= 246 umol/l.There was no impact to patient management reported.
Additional Manufacturer Narrative
The complaint investigation included a review of data and information provided by the customer, search for similar complaints, ticket trending review, device history record review and labeling review.Return testing was not completed as returns were not available.Data and information provided by the customer were reviewed and support the complaint issue without indication for any additional issue.A search for similar complaints did not identify an increase in complaint activity for lot 65669uq01.A ticket trending review of complaint lot 65669uq01 did not identify any related trends.A device history record review did not identify any nonconformances related to lot number 65669uq01 and complaint issue.Labeling was reviewed and sufficiently addresses the customer¿s issue.Based on the investigation, no systemic issue or deficiency of the alinity c total bilirubin reagent lot number 65669uq01 was identified.
Event or Problem Description
The customer observed a falsely depressed total bilirubin2 on the alinity c processing module for one male patient.The following results were provided (reference range < (b)(6): sid (b)(6), (b)(6) 2024, the first run of the sample generated an error code of 1041, reaction check failure on the alinity sn (b)(6); when repeated the initial bilirubin result= 2 umol/l.Repeat testing on the alinity sn (b)(6) generated the error code 1041 again; when repeated, after recentrifugation, results= 200.1 umol/l and 196.2 umol/l.Additional results were provided for historical/ additional comparison: (b)(6) 2024= 204 umol/l, (b)(6) 2024= 209 umol/l, (b)(6) 2024= 218 umol/l, (b)(6) 2024= 246 umol/l.There was no impact to patient management reported.

• Brand Name: ALINITY C TOTAL BILIRUBIN REAGENT KIT
• Common Device Name: DIAZO COLORIMETRY, BILIRUBIN
• Manufacturer (Section D): ABBOTT GMBH; max-planck-ring 2; wiesbaden 65205 ; GM 65205
• Manufacturer (Section G): ABBOTT GMBH; max-planck-ring 2; wiesbaden 65205 ; GM 65205
• Manufacturer Contact: nicole jenne ; max-planck-ring 2; post market surveillance; wiesbaden 65205 ; GM 65205 ; 6122582960
• MDR Report Key: 20555639
• Report Number: 3002809144-2024-00310
• Device Sequence Number: 8885826
• Product Code: CIG
• UDI-Device Identifier: 00380740158422
• UDI-Public: (01)00380740158422(17)250630(10)65669UQ01
• Combination Product (Y/N): N
• Initial Reporter Country: AS
• PMA/510(K) Number: K121985
• 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
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/15/2024

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: 06/30/2025
• Device Catalogue Number: 04V51-31
• Device Lot Number: 65669UQ01
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 10/10/2024
• Supplement Date Received by Manufacturer: 11/14/2024
• Initial Report FDA Received Date: 10/29/2024
• Supplement Report FDA Received Date: 11/15/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 03/15/2024
• 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: ALNTY C PROCESSING MODU, 03R67-01, (B)(6); ALNTY C PROCESSING MODU, 03R67-01, (B)(6)
• Patient Sex: Male