BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK COMPACT TEST DRUM

    MDR report key: 1061152 · Received June 13, 2008

    Report

    Report Number
    1823260-2008-04730
    Event Type
    Malfunction
    Date Received
    June 13, 2008
    Date of Event
    March 2, 2008
    Report Date
    June 13, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    REPORTER ALLEGED OBTAINING A DISCREPANT BLOOD GLUCOSE RESULT OF 51 MG/DL BACK TO BACK WITH A RESULT OF 120 MG/DL ON THE COMPACT SYSTEM WHEN TESTING WAS PERFORMED LESS THAN 10 MINUTES APART. REPORTER STATED THAT SHE SELF-TREATED WITH OJ. NO OTHER ACTIONS WERE REPORTED TAKEN OR TREATMENT RECEIVED. NO ADVERSE EVENT REPORTED. A REQUEST WAS MADE FOR THE RETURN OF THE SUSPECT DEVICE AND REPLACEMENT PRODUCT 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 20678841

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR ACTOS - 1 YEAR| HYZAAR - 1 YEAR| METFORMIN - 1 YEAR| "LEBOTROL" - 1 YEAR