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

Model Number TSH

Device Problem High Test Results (2457)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 11/01/2019

Event Type  malfunction  

Manufacturer Narrative

This event occurred in (b)(6).

Event Description

The initial reporter stated they received discrepant results for one patient sample tested with the elecsys tsh assay, the elecsys ft4 iii assay, elecsys ft3 iii, the elecsys t4 assay, elecsys t3, and the elecsys anti-tshr immunoassay on a cobas 8000 e 801 module and a second e 801 module used for investigation.No incorrect results were reported outside of the laboratory.This medwatch will apply to the tsh assay.Please refer to the medwatch with patient identifier (b)(6) for information related to the ft4 assay, refer to the medwatch with patient identifier (b)(6) for information related to the ft3 assay, refer to the medwatch with patient identifier (b)(6) for information related to the t4 assay, refer to the medwatch with patient identifier (b)(6) for information related to the t3 assay, and refer to the medwatch with patient identifier (b)(6) for information related to the anti-tshr assay.The sample was initially tested on the customer's e 801 analyzer on (b)(6) 2019.The sample was repeated using the architect method (for tsh, ft4, ft3, t4, t3) and yamasa method (for anti-tshr).The sample was provided for investigation where it was tested on a second e 801 analyzer on (b)(6) 2019.The serial number of the customer's e 801 analyzer was requested, but not provided.The serial number of the e 801 analyzer used for investigation is (b)(4).Tsh reagent lot number 386646, with an expiration date of may 2020 was used on this analyzer.

Manufacturer Narrative

The investigation could not identify a product problem.The cause of the event could not be determined.

• Brand Name: ELECSYS TSH ASSAY
• Type of Device: RADIOIMMUNOASSAY, THYROID-STIMULATING HORMONE
• Manufacturer (Section D): ROCHE DIAGNOSTICS; 9115 hague road; indianapolis IN 46250
• MDR Report Key: 9384222
• MDR Text Key: 218513747
• Report Number: 1823260-2019-90268
• Device Sequence Number: 1
• Product Code: JLW
• UDI-Device Identifier: 04015630939831
• UDI-Public: 04015630939831
• Combination Product (y/n): N
• PMA/PMN Number: K961491
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,health professional,u
• Type of Report: Initial,Followup
• Report Date: 12/23/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/27/2019
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: TSH
• Device Catalogue Number: 07028091190
• Device Lot Number: ASKU
• Was Device Available for Evaluation?: Yes
• Date Manufacturer Received: 11/01/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: THYRADIN.