BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SOFTCLIX PLUS LANCET DEVICE

    MDR report key: 1040943 · Received May 2, 2008

    Report

    Report Number
    1823260-2008-03720
    Event Type
    Malfunction
    Date Received
    May 2, 2008
    Date of Event
    March 29, 2008
    Report Date
    May 2, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    FMK
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTS LANCET STICKS OUT BEFORE AND AFTER BEING FIRED WHILE USING THE SOFTCLIX PLUS LANCET DEVICE. NO ACCIDENTAL STICK REPORTED. NO ADVERSE EVENT REPORTED. A REQUEST WAS MADE FOR RETURN OF THE SUSPECT PRODUCT AND A REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SOFTCLIX PLUS LANCET DEVICE LANCET DEVICE-FMK FMK ROCHE DIAGNOSTICS BAT060

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR RANITIDINE 30 MG 2X/DAY 4-5 YEARS| CLONIDINE 2 MG 2X/DAY 4-5 YEARS| LISINOPRIL 40 MG 2X/DAY 4-5 YEARS| FUROSEMIDE 40 MG/DAY 4-5 YYEARS| CYCLOBENZAPRINE 10 MG/DAY 4-5 YEARS| GLYBURIDE 5 MG 2X/DAY ABOUT A YEAR| FELODIPINE 10 MG/DAY 4-5 YEARS| CARVEDILOL 25 MG 2X/DAY 4-5 YEARS