BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK COMPACT TEST DRUM

    MDR report key: 1020213 · Received March 26, 2008

    Report

    Report Number
    1823260-2008-02780
    Event Type
    Malfunction
    Date Received
    March 26, 2008
    Date of Event
    March 21, 2008
    Report Date
    March 26, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AK, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    THE REPORTER STATES THAT HE OBTAINED A 465MG/DL AND 91MG/DL BLOOD GLUCOSE COMPARISON ON THE ACCU-CHEK COMPACT PLUS SYSTEM. THE RESULTS WERE OBTAINED WITHIN A 10 MINUTE TIMEFRAME. NO REPORTED ACTIONS TAKEN. NO ADVERSE EVENT REPORTED. NEW SYSTEM SENT TO CUSTOMER AND RETURN REQUESTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK COMPACT TEST DRUM BLOOD GLUCOSE MONITORING TEST STRIPS - LFR LFR ROCHE DIAGNOSTICS 20670143

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR METFORMIN 1000MG/2X - UNK FREQ| LANTUS 11UNITS/1X - UNK FREQ