inforMED
MalfunctionJGS

DIMENSION®

Received Jul 2, 2024 · Event occurred Jun 8, 2024

Report 2517506-2024-00177 · MDR key 19654609

Device

Generic name

Dimension® Quiklyte® Integrated Multisensor

Catalog number

S600 SMN 10445058

Lot number

4AD803

Product problems

  • High Test Results
  • High Test Results

Patient

NA · Unknown

  • No Clinical Signs, Symptoms or Conditions
  • No Clinical Signs, Symptoms or Conditions

Narrative

Additional Manufacturer Narrative

A UNITED STATES CUSTOMER CONTACTED THE SIEMENS HEALTHCARE DIAGNOSTICS REMOTE SERVICES CENTER (RSC) REGARDING AN ERRONEOUSLY ELEVATED SODIUM (NA) PATIENT SAMPLE RESULT OBTAINED ON A DIMENSION® EXL¿ 200 INTEGRATED CHEMISTRY SYSTEM. SIEMENS IS INVESTIGATING THE EVENT.

Description of Event or Problem

THE CUSTOMER REPORTED TO SIEMENS THAT THEY OBTAINED AN ERRONEOUSLY ELEVATED SODIUM (NA) PATIENT SAMPLE RESULT ON A DIMENSION® EXL¿ 200 INTEGRATED CHEMISTRY SYSTEM. THE ERRONEOUS PATIENT RESULT WAS NOT REPORTED TO THE PHYSICIAN. THE SAME SAMPLE WAS AUTO REPROCESSED ON THE SAME DIMENSION® EXL¿ 200 INTEGRATED CHEMISTRY SYSTEM AND A LOWER RESULT WAS OBTAINED. THE SAME SAMPLE WAS REPROCESSED ON THE SAME DIMENSION® EXL¿ 200 INTEGRATED CHEMISTRY SYSTEM AND A LOWER RESULT WAS REPRODUCED. THE AUTO-REPROCESSED RESULT WAS REPORTED TO THE PHYSICIAN AS THE CORRECT RESULT. THERE ARE NO KNOWN REPORTS OF PATIENT INTERVENTION OR ADVERSE HEALTH CONSEQUENCES DUE TO THE ERRONEOUSLY ELEVATED SODIUM (NA) RESULT.

Additional Manufacturer Narrative

ADDITIONAL INFORMATION (15-JUL-2024): SIEMENS HEALTHCARE DIAGNOSTICS HEADQUARTERS SUPPORT CENTER (HSC) CONCLUDED THE INVESTIGATION OF THE EVENT. HSC EVALUATED THE INFORMATION PROVIDED BY THE CUSTOMER. CALIBRATION AND QUALITY CONTROL (QC) RECOVERY WAS WITHIN THE CUSTOMER¿S EXPECTED RANGES, AND NO ISSUES WERE REPORTED WITH THE OTHER PATIENT SAMPLES, INDICATING THAT THE SODIUM (NA) ASSAY WAS PERFORMING ACCEPTABLY. THERE WERE NO ISSUES IDENTIFIED WITH THE INSTRUMENT. THE CAUSE OF THE EVENT IS UNKNOWN. THE CUSTOMER IS OPERATIONAL. THE DEVICE IS PERFORMING WITHIN SPECIFICATIONS. NO FURTHER EVALUATION IS REQUIRED. SECTION H6 HAS BEEN UPDATED TO REFLECT THE HSC INVESTIGATION. INITIAL MDR 2517506-2024-00177 WAS FILED ON 02-JUL-2024.