BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK COMPACT TEST DRUM

    MDR report key: 1040389 · Received May 7, 2008

    Report

    Report Number
    1823260-2008-03809
    Event Type
    Malfunction
    Date Received
    May 7, 2008
    Date of Event
    April 30, 2008
    Report Date
    May 7, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTED METER RESULTS OF 120 MG/DL AND 276 MG/DL WITHIN 10 MINUTES ON THE AVIVA SYSTEM. CUSTOMER REPORTED NO SYMPTOMS, DID NOT TREAT OR ACT ON RESULTS. NO ADVERSE EVENT REPORTED. A REQUEST WAS MADE FOR THE RETURN OF THE SYSTEM, REPLACEMENT WAS SENT.

    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 20663341

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR DIOVAN 80MG/DAY| METFORMIN 500MG/2/DAY| ATENOLOL 81MG/DAY| CALCIUM 600MG/2/DAY| SIMVASTATIN 20MG/DAY| "FLUID PILL" 20MG/DAY