BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK AVIVA TEST STRIPS

    MDR report key: 1082576 · Received July 23, 2008

    Report

    Report Number
    1823260-2008-05699
    Event Type
    Malfunction
    Date Received
    July 23, 2008
    Date of Event
    July 19, 2008
    Report Date
    July 23, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K043474
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AK, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    THE CUSTOMER OBTAINED A 193MG/DL, 97MG/DL AND 115MG/DL ON THE ACCU-CHEK AVIVA SYSTEM. THE TEST RESULTS WERE OBTAINED WITHIN A 10 MINUTE TIMEFRAME. NO ACTION WAS TAKEN BASED ON THE RESULTS. 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 300756

    Patients

    Seq Age Sex Outcome Treatment
    1 28 YR PRENATAL VITAMINS - 30 WEEKS