BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK AVIVA TEST STRIPS

    MDR report key: 1123933 · Received August 15, 2008

    Report

    Report Number
    1823260-2008-06257
    Event Type
    Malfunction
    Date Received
    August 15, 2008
    Date of Event
    August 13, 2008
    Report Date
    August 15, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K043474
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CT, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTS BACK TO BACK TESTING ON THE SAME METER WHILE USING THE AVIVA SYSTEM WITH RESULTS OF 81 MG/DL, 82MG/DL, 187 MG/DL AND 74MG/DL. NO QUALITY CONTROLS WERE RUN. 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 ACCU-CHEK AVIVA TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS - LFR LFR ROCHE DIAGNOSTICS 301325

    Patients

    Seq Age Sex Outcome Treatment
    1 85 YR "MYLARICAN"| "DUKIZIDE"| METFORMIN| "LYCONOPREN"| GLIPIZIDE| LORCET| HYDROCHLOROTHIAZIDE| DILTIAZEM| "FLOROCIMIDEN"