MAUDE Adverse Event Report: SIEMENS HEALTHCARE DIAGNOSTICS INC. DIMENSION VISTA®; DIMENSION VISTA® MULTI 1 SAMPLE DILUENT

Catalog Number	KD693 SMN 10469971
Medical Device Problem Code	High Test Results (2457)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	10/04/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Siemens healthcare diagnostics has confirmed that dimension vista® multi 1 sample diluent (multi 1 sdil) lot 7bda81 may have an incomplete slit on the septum in the cap of the vial.A diluent cap with a defective septum has the potential to cause erroneously elevated results if a sample is autodiluted onboard the dimension vista system, due to a reduced volume of diluent being pipetted from the vial.Multi 1 sample diluent (multi 1 sdil) is used for dilutions of samples exceeding the analytical measurement range with the dimension vista® estradiol (e2) flex reagent cartridge.Urgent medical device recall, (b)(4) dated (b)(6) 2018 and urgent field safety notice (b)(4) dated (b)(6) 2018 were issued to customers who had been shipped dimension vista® multi 1 sample diluent (multi 1 sdil) lot 7bda81 to inform them of the issue.
Event or Problem Description
A falsely elevated estradiol (e2) result was obtained on a cap survey sample on the dimension vista 1500 instrument.The result was scored as unacceptable by the cap.The customer stated that no patient samples have been affected.

• Brand Name: DIMENSION VISTA®
• Common Device Name: DIMENSION VISTA® MULTI 1 SAMPLE DILUENT
• Manufacturer (Section D): SIEMENS HEALTHCARE DIAGNOSTICS INC.; 500 gbc drive; po box 6101; newark DE 19714 6101
• MDR Report Key: 7371142
• Report Number: 2517506-2018-00195
• Device Sequence Number: 13649540
• Product Code: NDR
• UDI-Device Identifier: 00842768030314
• UDI-Public: 00842768030314
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: health professional,user faci
• Initial Reporter Occupation: Health Professional
• Remedial Action: Recall
• Type of Report: Initial
• Report Date (Section B): 03/26/2018

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: 03/01/2018
• Device Catalogue Number: KD693 SMN 10469971
• Device Lot Number: 7BDA81
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 03/13/2018
• Initial Report FDA Received Date: 03/26/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement: 2517506-03/22/2018-002-R
• Patient Sequence Number: 1