inforMED
MalfunctionJKC

ELECSYS DHEA-S

Received Apr 4, 2025 · Event occurred Mar 7, 2025

Report 1823260-2025-01007 · MDR key 21772689

Device

Generic name

Dehydroepiandrosterone Test System

Manufacturer

Roche Diagnostics

Catalog number

07027192190

Lot number

790997

Product problems

  • Incorrect, Inadequate or Imprecise Result or Readings
  • High Test Results
  • Non Reproducible Results
  • Incorrect, Inadequate or Imprecise Result or Readings
  • High Test Results
  • Non Reproducible Results

Patient

14 YR · Female

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

Narrative

Additional Manufacturer Narrative

QC WAS IN RANGE PRIOR TO THE EVENT. THERE WEREN'T ANY RELEVANT INSTRUMENT ALARMS OR SAMPLE QUALITY ALARMS ON THE DAY OF THE EVENT THE INVESTIGATION WAS UNABLE TO DETERMINE A DIRECT ROOT CAUSE.

Description of Event or Problem

THERE WAS AN ALLEGATION OF A QUESTIONABLE ELECSYS DHEA-S RESULT FROM THE COBAS E 402 ANALYTICAL UNIT. THE INITIAL RESULT WAS 407.0 UG/DL, AND THE REPEAT RESULT WAS 221 UG/DL. THE QUESTIONABLE RESULT WAS REPEATED BECAUSE THE CUSTOMER NOTICED THAT IT WAS VERY HIGH FOR THE PATIENT'S AGE, AND IT WAS NOT RELEASED TO THE PATIENT.

Additional Manufacturer Narrative

THE COBAS E 402 ANALYTICAL UNIT SERIAL NUMBER IS (B)(6). THE INVESTIGATION IS ONGOING.