MAUDE Adverse Event Report: AZURE BIOTECH, INC. FASTEP COVID-19 ANTIGEN HOME TEST

Catalog Number	COV-S23010H2
Medical Device Problem Code	False Negative Result (1225)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	09/04/2024
Type of Reportable Event	Malfunction
Event or Problem Description
User received a positive test at the doctor's office and decided to purchase these tests to check progress of infection.All tests taken after doctors office were negative.User decided to use a different brand which showed positive results.
Additional Manufacturer Narrative
Customer contacted for a refund/ replacement through amazon, but no response was provided.

• Brand Name: FASTEP COVID-19 ANTIGEN HOME TEST
• Common Device Name: COVID-19 ANTIGEN HOME TEST
• Manufacturer (Section D): AZURE BIOTECH, INC.; 10400 main st; houston TX 77025
• Manufacturer Contact: frank luo ; 10400 main st; houston, TX 77025 ; 7135615529
• MDR Report Key: 20675795
• Report Number: 3014862351-2024-00011
• Device Sequence Number: 18366121
• Product Code: QYT
• UDI-Device Identifier: 00810022630358
• UDI-Public: 810022630358
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: EUA220191
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 11/13/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Expiration Date: 01/02/2025
• Device Catalogue Number: COV-S23010H2
• Device Lot Number: I2301009
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 09/04/2024
• Initial Report FDA Received Date: 11/13/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 01/03/2023
• 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 Sex: Male