MAUDE Adverse Event Report: ABBOTT LABORATORIES PRISM HBSAG

Catalog Number	06D19-68
Medical Device Problem Code	False Positive Result (1227)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
An evaluation is in process.A follow-up report will be submitted when the evaluation is complete.
Event or Problem Description
The customer reports that donor samples (b)(6) generated initial and repeat (b)(6) results with the abbott prism hbsag assay reagent lot 81091m500 on the abbott prism analyzer serial number (b)(4).The customer does not perform confirmatory testing at their facility.The samples were therefore sent to another lab and tested with the abbott prism hbsag confirmatory assay and were confirmed (b)(6).The same samples tested (b)(6) with an nat procedure.No suspect results were reported from the lab.There is no impact to donor management reported.
Additional Manufacturer Narrative
The donors were contacted and asked to return for retesting.The results were non-reactive.Contamination and possible receipt of the hepatitis b vaccine were ruled out by the customer as possible reasons for the initial false reactive results.Master lot used in the testing on (b)(6) 2018 was 82069m500.For reagent lot 81091m500, one other customer had registered a complaint.Therefore, no problematic complaint activity was identified that would indicate this product was performing contrary to claims.
Additional Manufacturer Narrative
A review of complaint tracking and trending metrics was performed and identified no related adverse or non-statistical trends in conjunction with the complaint issue currently under evaluation.No non-conformances, potential non-conformances or deviations were found, which may have impacted the performance of the product.A review of field data was performed.(b)(4).Both the initial and repeat reactive rates as well as the specificity are within assay package insert specifications.The prism hbsag assay package insert provides information to address the current customer issue.Based on the available information from the customer site and the results of this evaluation, there is no evidence to reasonably suggest that a systemic issue or product deficiency exists.

• Brand Name: PRISM HBSAG
• Common Device Name: HBSAG
• Manufacturer (Section D): ABBOTT LABORATORIES; 100 abbott park road; abbott park IL 60064 3500
• MDR Report Key: 7387577
• Report Number: 1415939-2018-00068
• Device Sequence Number: 10806410
• Product Code: KSJ
• UDI-Device Identifier: 00380740062989
• UDI-Public: 00380740062989
• Combination Product (Y/N): N
• Initial Reporter State: TN
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Medical Technologist
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 05/17/2018

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: 09/12/2018
• Device Catalogue Number: 06D19-68
• Device Lot Number: 81091M500
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 03/12/2018
• Supplement Date Received by Manufacturer: 04/06/2018; 04/30/2018
• Initial Report FDA Received Date: 03/31/2018
• Supplement Report FDA Received Date: 04/09/2018; 05/17/2018
• 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: ABBOTT PRISM ANALYZER LN: 06A36-11.; ABBOTT PRISM ANALYZER LN: 06A36-11.; ABBOTT PRISM ANALYZER LN: 06A36-11.; SN: (B)(4).; SN: (B)(4).; SN: (B)(4).