VITROS CHEMISTRY PRODUCTS CRBM SLIDES 8892382

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2015-05-21 for VITROS CHEMISTRY PRODUCTS CRBM SLIDES 8892382 manufactured by Ortho-clinical Diagnostics.

Event Text Entries

[20448037] The customer reported that higher than expected crbm, lac and phyt results were obtained from multiple investigational-only samples when using vitros chemistry products crmb, lac and phyt reagents on a vitros 5,1 fs instrument. (b)(6). Biased results of the magnitude and direction observed may lead to inappropriate physician action. Patient results were not affected; however, the investigation cannot conclude that patient samples would not be affected if the event were to recur undetected. There was no allegation of patient harm as a result of these events. This report is number two of twelve mdr? S for this event. Twelve 3500a forms are being submitted for this event as twelve devices were involved. This report corresponds to ortho clinical diagnostics inc. (b)(4).
Patient Sequence No: 1, Text Type: D, B5


[20689809] The investigation determined that higher than expected crbm, lac and phyt results were obtained from multiple investigational-only samples when using vitros chemistry products crmb, lac and phyt reagents on a vitros 5,1 fs instrument. The assignable cause of the events is most likely related to the n-acetyl cysteine (nac) that was added to the samples, and interferes with the vitros crbm, lac and phyt micro slide assays. The investigation is ongoing. A vitros micro slide issue cannot be ruled out for any of the affected assays; however, the investigation was able to rule out an unexpected vitros 5,1 fs system malfunction.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number1319809-2015-00084
MDR Report Key4787892
Report Source05
Date Received2015-05-21
Date of Report2015-05-21
Date of Event2015-04-22
Date Mfgr Received2015-04-22
Device Manufacturer Date2015-03-07
Date Added to Maude2015-06-22
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactMR. JAMES A STEVENS
Manufacturer Street100 INDIGO CREEK DRIVE
Manufacturer CityROCHESTER NY 14626
Manufacturer CountryUS
Manufacturer Postal14626
Manufacturer Phone5854533000
Manufacturer G1ORTHO-CLINICAL DIAGNOSTICS
Manufacturer Street513 TECHNOLOGY BLVD.
Manufacturer CityROCHESTER NY 14652
Manufacturer CountryUS
Manufacturer Postal Code14652
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameVITROS CHEMISTRY PRODUCTS CRBM SLIDES
Generic NameIN-VITRO DIAGNOSTIC
Product CodeKLT
Date Received2015-05-21
Catalog Number8892382
Lot Number3928-0087-2027
Device Expiration Date2015-11-01
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerORTHO-CLINICAL DIAGNOSTICS
Manufacturer Address100 INDIGO CREEK DRIVE ROCHESTER NY 14626 US 14626


Patients

Patient NumberTreatmentOutcomeDate
10 2015-05-21

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