BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COAGUCHEK S SYSTEM

    MDR report key: 1070165 · Received July 3, 2008

    Report

    Report Number
    1823260-2008-05169
    Event Type
    Malfunction
    Date Received
    July 3, 2008
    Date of Event
    June 17, 2008
    Report Date
    July 3, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    JPA
    PMA / PMN Number
    K974569
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WV, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    CUSTOMER STATES THE PATIENT TESTED 8.0 INR ON THE COAGUCHEK S SYSTEM WHILE A COMPARISON LAB RETURNED AS 6.1 INR. PATIENT'S COUMADIN WAS HELD FOR THREE DAYS BASED ON THE METER RESULT. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT SYSTEM AND REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COAGUCHEK S SYSTEM PROTHROMBIN TIME TEST STRIPS - JPA JPA ROCHE DIAGNOSTICS 705A-F10

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKK COUMADIN 3MG DAILY