ANALYTICAL P MODULE 03738965692

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,user faci report with the FDA on 2017-06-30 for ANALYTICAL P MODULE 03738965692 manufactured by Roche Diagnostics.

Event Text Entries

[79032065] (b)(4). Unique identifier (udi): na.
Patient Sequence No: 1, Text Type: N, H10


[79032066] The customer stated that they received erroneous results for two patient samples tested for tg triglycerides gpo-pap (trig) on an analytical p module (pmod). Of the two samples, one had an erroneous initial result that was reported outside of the laboratory to the physician. The repeat result was believed to be correct. The sample was processed on an modular preanalytics system (mpa) prior to testing on the p module. As the sample had already come processed from another facility where the sample was collected, the sample was not centrifuged on the mpa system. There was some fibrin in the sample tube. The sample initially resulted as 475 mg/dl. The sample was repeated three times on (b)(6) 2017, resulting as 83 mg/dl, 81 mg/dl, and 83 mg/dl. The patient was not adversely affected. The trig reagent lot number was 21191101, with an expiration date of 01/31/2018. The field service engineer determined that the rinse mechanism was misadjusted. He adjusted the rinse mechanism so that it was within specifications and replaced a heat cut filter. The operator ran calibrations, quality controls, and patient samples; all were ok. The customer later called back and stated that they received erroneous results for four additional patient samples tested for trig on (b)(6) 2017 after service actions had been performed. No erroneous results were reported outside of the laboratory for these samples. The customer was advised to change the reagent bottle with one from a new shipment, then run precision studies with the new bottle. The customer did this and stated that there was one outlier result with the precision. Based on this precision study, it was agreed that there was not a reagent shipment issue. The field service engineer returned to the site and found a faulty gear pump head, causing a fluidics failure. He replace the gear pump head, vacuum diaphragm, valves, the heat cut filter, cells, and lamp. He ran precision studies.
Patient Sequence No: 1, Text Type: D, B5


[120549110] The customer encountered erroneous results for two additional patient samples tested for trig. The erroneous results for these samples were not reported outside of the laboratory. The field service engineer and field application specialist determined that there was a possible carryover issue. A third party test was installed on the analyzer, but the appropriate washes were not programmed on the instrument. The reaction cells on the instrument were changed and the location of the third party reagent was moved. Proper washes were programmed on the analyzer and precision testing was performed for trig; all results were within specifications. No further sample issues were encountered.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number1823260-2017-01389
MDR Report Key6681659
Report SourceHEALTH PROFESSIONAL,USER FACI
Date Received2017-06-30
Date of Report2017-07-20
Date of Event2017-06-07
Date Mfgr Received2017-06-19
Date Added to Maude2017-06-30
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag0
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationMEDICAL TECHNOLOGIST
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactNA MICHAEL LESLIE
Manufacturer Street9115 HAGUE ROAD NA
Manufacturer CityINDIANAPOLIS IN 46250
Manufacturer CountryUS
Manufacturer Postal46250
Manufacturer Phone3175214343
Manufacturer G1HITACHI HIGH TECH CORP.
Manufacturer Street882 ICHIGE HITACHINAKA NA
Manufacturer CityIBARAKI 312-8504
Manufacturer CountryJA
Manufacturer Postal Code312-8504
Single Use3
Previous Use Code3
Removal Correction NumberNA
Event Type3
Type of Report3

Device Sequence Number: 0

Brand NameANALYTICAL P MODULE
Generic NameCLINICAL CHEMISTRY ANALYZER
Product CodeJGY
Date Received2017-06-30
Model NumberP MODULE
Catalog Number03738965692
Lot NumberNA
ID NumberNA
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No0
Device Event Key0
ManufacturerROCHE DIAGNOSTICS
Manufacturer Address9115 HAGUE ROAD NA INDIANAPOLIS IN 462500457 US 462500457

Device Sequence Number: 1

Brand NameANALYTICAL P MODULE
Generic NameCLINICAL CHEMISTRY ANALYZER
Product CodeJJE
Date Received2017-06-30
Model NumberP MODULE
Catalog Number03738965692
Lot NumberNA
ID NumberNA
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerROCHE DIAGNOSTICS
Manufacturer Address9115 HAGUE ROAD NA INDIANAPOLIS IN 462500457 US 462500457


Patients

Patient NumberTreatmentOutcomeDate
10 2017-06-30

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