BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK MULTICLIX

    MDR report key: 1033173 · Received April 23, 2008

    Report

    Report Number
    1823260-2008-03473
    Event Type
    Malfunction
    Date Received
    April 23, 2008
    Date of Event
    April 10, 2008
    Report Date
    April 23, 2008
    Manufacturer
    ROCHE DIAGNOSTICS CORP.
    Product Code
    FMK
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTS LANCET STICKS OUT OF THE CAP OF THE MULTICLIX DEVICE; UNK IF BEFORE OR AFTER FIRING. NO ACCIDENTAL NEEDLE STICK OCCURRED. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT DEVICE AND REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK MULTICLIX LANCET DEVICE -FMK FMK ROCHE DIAGNOSTICS CORP. NI

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR METFORMIN "50MG" X 2 - 5 MOS| LANTUS "30MG" X 1 - 5 MOS