MAUDE Adverse Event Report: ABBOTT POINT OF CARE I-STAT EG6+ CARTRIDGE

Catalog Number	03P77-25
Medical Device Problem Code	Incorrect, Inadequate or Imprecise Result or Readings (1535)
Health Effect - Clinical Codes	Inflammation (1932); Pain (1994); Septic Shock (2068)
Date of Event	10/04/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).Apoc labeling will be evaluated during the investigation as pertaining to the event.
Event or Problem Description
On (b)(6) 2018, abbott point of care (apoc) was contacted by a customer regarding i-stat eg6+ cartridges that yielded a suspected discrepant hemoglobin result on a (b)(6) male patient with epigastric pain x 3 days, and vomiting x3 episodes.There was no additional patient information at the time of this report.Return product is not available for investigation.Method, date, time, hct, hgb.I-stat, (b)(6) 2018, unk, 43%, 14.6 g/dl; lab, (b)(6) 2018, 0538, 26.6%, 8.6 g/dl.Collection times are unknown.There are no injuries associated with this event.At this time there is no reason to suspect a malfunction exists.The reporting decision was based on information available that suggests the product was not performing within the variability of the assay.The investigation is underway.
Additional Manufacturer Narrative
Apoc incident #: (b)(4).The investigation was completed on 11/09/2018.A review of the device history record confirmed the lot passed finished goods release criteria.Retain cartridge test results met the acceptance criteria found in q04.01.003 rev.Ac, appendix 1- product complaint level 2 and level 3 investigation procedure.No deficiency has been identified.

• Brand Name: I-STAT EG6+ CARTRIDGE
• Common Device Name: EG6+ CARTRIDGE
• Manufacturer (Section D): ABBOTT POINT OF CARE; 400 college road; princeton NJ 08540 6607
• MDR Report Key: 8001395
• Report Number: 2245578-2018-00265
• Device Sequence Number: 16420189
• Product Code: CHL
• UDI-Device Identifier: 10054749000057
• UDI-Public: 10054749000057
• Combination Product (Y/N): N
• Initial Reporter Country: SN
• PMA/510(K) Number: K940918
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/13/2018

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: 02/02/2019
• Device Catalogue Number: 03P77-25
• Device Lot Number: W18156
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 10/13/2018
• Supplement Date Received by Manufacturer: 11/09/2018
• Initial Report FDA Received Date: 10/24/2018
• Supplement Report FDA Received Date: 11/13/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): Yes
• Patient Sequence Number: 1
• Patient Age: 80 YR