MAUDE Adverse Event Report: ABBOTT POINT OF CARE I-STAT E3+ CARTRIDGE

Catalog Number	03P82-25
Medical Device Problem Code	Incorrect, Inadequate or Imprecise Result or Readings (1535)
Health Effect - Clinical Code	No Information (3190)
Date of Event	10/08/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Apoc incident (b)(4).Apoc labeling will be evaluated during the investigation as pertaining to the event.
Event or Problem Description
On (b)(6) 2019, abbott point of care was contacted by a customer regarding i-stat e3+ cartridges that yielded a suspected discrepant potassium results of >9.0 on a (b)(6) year old male patient presented for cardiac surgery.Nurse stated that due to k results of >9.0 mmol/l, patient was given 5 unit of insulin and amp of d50.The patient was transferred to (b)(6) hospital, and the k result there was 4.0 mmol/l (test time: unknown).There was no additional patient information available at the time of this report.Return product is not available for investigation.Method: i-stat, date: 08-oct-2019, tested: 08:25, result: >9.0 mmol/l.I-stat, 08-oct-2019, 08:xx, >9.0 mmol/l.Lab, 08-oct-2019, unk, 4.0 mmol/l.Collection times not provided.Lab collection and test 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 limited 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 12/09/2019.A review of the device history record (dhr) confirmed the cartridge lot met finished goods (fg) release criteria.Retained testing met the acceptance criteria outlined in appendix 1 of q04.01.003 rev.Ad (product complaint level 2 and level 3 investigation procedure).No deficiency has been determined for e3+ lot j19065.

• Brand Name: I-STAT E3+ CARTRIDGE
• Common Device Name: E3+ CARTRIDGE
• Manufacturer (Section D): ABBOTT POINT OF CARE; 400 college road; princeton NJ 08540 6607
• MDR Report Key: 9202879
• Report Number: 2245578-2019-00247
• Device Sequence Number: 3031396
• Product Code: JGS
• UDI-Device Identifier: 10054749000101
• UDI-Public: 10054749000101
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K912387
• 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): 12/11/2019

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: 03/05/2020
• Device Catalogue Number: 03P82-25
• Device Lot Number: J19065
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 10/09/2019
• Supplement Date Received by Manufacturer: 12/09/2019
• Initial Report FDA Received Date: 10/17/2019
• Supplement Report FDA Received Date: 12/11/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 76 YR