MAUDE Adverse Event Report: MERIDIAN BIOSCIENCE, INC. IMMUNOCARD STAT! EHEC; E. COLI SEROLOGICAL REAGENT

Model Number	751630
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Death (1802)
Date of Event	07/18/2017
Type of Reportable Event	Death
Additional Manufacturer Narrative
Review of final release quality control testing indicates test performing according to established specifications.Evaluation of retain kit lot from same lot tested by manufacturer on (b)(6) 2017 using positive control, negative control, and qualified toxin 2 (+) / toxin 1 (-) broth samples.Control results were valid.Qualified specimens returned expected results.Review of complaint records shows no other complaints reported for kit lot.(b)(4).
Event or Problem Description
Manufacturer became aware of death of (b)(6) year old, female due to complications arising from e.Coli infection, hemolytic uremic syndrome (hus).Patient had been tested using immunocard stat! ehec product, negative results reported.Notification of patient death was received on (b)(6), by manufacturer personnel during routine sales call with testing facility.The following information was collected by (b)(6).Complaint handling department (technical service): inside sales representative notified technical service that customer disclosed patient tested for ehec at their facility had expired.Patient test result was reported as 'negative' by (b)(6) immunocard stat! ehec, catalog 751630.Patient was transferred to another facility and was tested for ehec.Patient results reported as 'toxin 2 positive' at other facility.Sometime between the initial testing and the subsequent testing, patient was treated with antibiotics.Patient died.Technical service personnel contacted customer as follow-up.Technical service was advised by the customer that they were not able to give any additional details regarding the situation.Technical service personnel reviewed testing and procedure with customer.Customer reported using gn broth for testing.Customer accepts preserved and unpreserved specimens.Customer has seen no issues with testing or qc.The person performing the test is an experienced user.Specimen is no longer available for additional testing.Technical service personnel requested contact information for infectious disease doctor who first notified customer and attempted to make contact.Form 3500 was sent.The following information was obtained on (b)(6) 2017 from infectious disease doctor: patient and sibling were taken to customer facility where they were admitted and tested for stool pathogens.Both children were tested for ehec and campylobacter; results for both tests were reported as 'negative'.Customer facility uses immunocard stat! ehec and culture for campylobacter.Both childred were diagnosed with hemolytic uremic syndrome (hus) from a combination of different laboratories and were transferred to alternate facility.Alternate facility reported to use verigene enteric pathogens (ep) for testing.Sibling was treated and released.

• Brand Name: IMMUNOCARD STAT! EHEC
• Common Device Name: E. COLI SEROLOGICAL REAGENT
• Manufacturer (Section D): MERIDIAN BIOSCIENCE, INC.; 3471 river hills drive; cincinnati OH 45244
• MDR Report Key: 6906530
• Report Number: 1524213-2017-00001
• Device Sequence Number: 19197647
• Product Code: GMZ
• UDI-Device Identifier: 00840733101366
• UDI-Public: (01)00840733101366(17)20180914(01)HC08225
• Combination Product (Y/N): Y
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: K062546
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Medical Technologist
• Type of Report: Initial
• Report Date (Section B): 07/18/2017

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?: No
• Operator of Device: Medical Technologist
• Device Expiration Date: 09/14/2018
• Device Model Number: 751630
• Device Catalogue Number: 751630
• Device Lot Number: HC08225
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Device Age: 4 MO
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/18/2017
• Initial Report FDA Received Date: 09/29/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Death
• Patient Age: 3 YR
• Patient Weight: 14