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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ROCHE DIAGNOSTICS ELECSYS TSH ASSAY; RADIOIMMUNOASSAY, THYROID-STIMULATING HORMONE

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ROCHE DIAGNOSTICS ELECSYS TSH ASSAY; RADIOIMMUNOASSAY, THYROID-STIMULATING HORMONE Back to Search Results
Catalog Number 07028091190
Device Problem Incorrect Or Inadequate Test Results (2456)
Patient Problem No Consequences Or Impact To Patient (2199)
Event Date 05/11/2018
Event Type  malfunction  
Manufacturer Narrative
This event occurred in (b)(6).(b)(4) - (b)(4).
 
Event Description
The customer questioned thyroid results for 3 patient samples tested for elecsys tsh (tsh), elecsys ft4 ii (ft4 ii), and elecsys ft3 iii (ft3 iii) on a cobas e 801 module.The 3 patient samples were submitted for investigation where discrepant results were identified for tsh, ft4 ii and ft3 iii between the customer's e801 module, the centaur method, an e801 module used at the investigation site, a cobas 8000 e 602 module used at the investigation site and a cobas e 411 immunoassay analyzer used at the investigation site.It is not known if any incorrect results were reported outside of the laboratory.This medwatch will cover tsh.Refer to medwatch with patient identifier (b)(6) for information on the ft4 ii erroneous results and medwatch with patient identifier (b)(6) for information on the ft3 iii erroneous results.Refer to attached data titled "patient results" for the patient results.There was no allegation that an adverse event occurred.The serial number for the customer's e801 module was not provided.The patient samples were also treated and underwent polyethylene glycol (peg) testing.Refer to attached data titled "peg testing" for these results.The e602 module serial number was (b)(4).The e411 analyzer serial number was (b)(4).The e801 module serial number used at the investigation site was (b)(4).The tsh reagent lot number used with the e602 module was 291617 with an expiration date of 31-jul-2018.The tsh reagent lot number used with the e411 analyzer was 274071 with an expiration date of 31-may-2018.The tsh reagent lot number used with the e801 module at the investigation site was 283556 with an expiration date of 28-feb-2019.
 
Manufacturer Narrative
The investigation was unable to find a definitive root cause for sample id's: (b)(6) tested for tsh and ft4 ii.Assays from different manufacturers can generate different results.
 
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Brand Name
ELECSYS TSH ASSAY
Type of Device
RADIOIMMUNOASSAY, THYROID-STIMULATING HORMONE
Manufacturer (Section D)
ROCHE DIAGNOSTICS
9115 hague road
indianapolis IN 46250 0457
MDR Report Key7577255
MDR Text Key110730677
Report Number1823260-2018-01769
Device Sequence Number1
Product Code JLW
Combination Product (y/n)N
PMA/PMN Number
K961491
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type foreign,health professional,u
Type of Report Initial,Followup
Report Date 07/03/2018
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received06/07/2018
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Catalogue Number07028091190
Device Lot NumberASKU
Was Device Available for Evaluation? Yes
Date Manufacturer Received05/21/2018
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
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