BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHECK COMPACT TEST DRUM

    MDR report key: 1181021 · Received September 29, 2008

    Report

    Report Number
    1823260-2008-07228
    Event Type
    Malfunction
    Date Received
    September 29, 2008
    Date of Event
    September 21, 2008
    Report Date
    September 29, 2008
    Manufacturer
    ROCHE DIAGNOSTICS .
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTED BLOOD GLUCOSE RESULTS OF 16 MG/DL AND 165 MG/DL WITHIN 10 MINUTES ON THE COMPACT PLUS SYSTEM. HE REPORTED NO SYMPTOMS, DID NOT TREAT OR ACT ON RESULTS. NO ADVERSE EVENT REPORTED. A REQUEST WAS MADE FOR THE RETURN OF THE SYSTEM, REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHECK COMPACT TEST DRUM BLOOD GLUCOSE MONITORING TEST STRIPS - LFR LFR ROCHE DIAGNOSTICS . 20684541

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR JANUVIA - 50 MG/DAY| METFORMIN - 1000 MG/DAY