BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COAGUCHEK XS SYSTEM

    MDR report key: 1002709 · Received February 8, 2008

    Report

    Report Number
    1823260-2008-01406
    Event Type
    Malfunction
    Date Received
    February 8, 2008
    Date of Event
    January 18, 2008
    Report Date
    February 8, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    GJS
    PMA / PMN Number
    K062925
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    THE PATIENT REPORTEDLY TESTED 3.8 INR ON THE COAGUCHEK XS SYSTEM AND 2.8 INR ON A COMPARISON LAB. COUMADIN REMAINED UNCHANGED BASED ON LAB RESULT. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT SYSTEM AND REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COAGUCHEK XS SYSTEM PROTHROMBIN TIME TEST STRIPS - GJS GJS ROCHE DIAGNOSTICS 20155321

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR COUMADIN - 7.5MG/DAY| MIXCILLITINE - 400MG/DAY| COREG - 37MG/DAY