BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK AVIVA TEST STRIPS

    MDR report key: 1032686 · Received April 22, 2008

    Report

    Report Number
    1823260-2008-03420
    Event Type
    Malfunction
    Date Received
    April 22, 2008
    Date of Event
    April 17, 2008
    Report Date
    April 22, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K043474
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTEDLY OBTAINED RESULTS OF 585MG/DL AND 113MG/DL ON THE AVIVA SYS WITHIN 10 MINS. NO ACTION TAKEN ON DEVICE RESULTS. 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 ACCU-CHEK AVIVA TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS - LFR LFR ROCHE DIAGNOSTICS 300773

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR GLIMEPIRIDE - 3 YEARS 4MG/DAY| NOVOLOG - 2 YEARS 38 UNITS/DAY