BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK AVIVA TEST STRIPS

    MDR report key: 1051713 · Received May 19, 2008

    Report

    Report Number
    1823260-2008-04122
    Event Type
    Malfunction
    Date Received
    May 19, 2008
    Date of Event
    May 12, 2008
    Report Date
    May 19, 2008
    Manufacturer
    ROCHE DIAGNOSTICS CORP.
    Product Code
    LFR
    PMA / PMN Number
    K043474
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    THE REPORTER STATES THAT SHE OBTAINED THE BLOOD GLUCOSE RESULTS OF 267 MG/DL AND 101 MG/DL ON THE ACCU-CHEK AVIVA SYSTEM. THE RESULTS WERE OBTAINED WITHIN A TEN MIN 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 AVIVA TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS - LFR LFR ROCHE DIAGNOSTICS CORP. 301016

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR BYETTA 5 "MG"/2X| NOVOLOG SLIDING SCALE| HUMALOG 75/25 10 UNITS/2X