BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK COMPACT TEST DRUM

    MDR report key: 1191530 · Received September 26, 2008

    Report

    Report Number
    1823260-2008-07198
    Event Type
    Malfunction
    Date Received
    September 26, 2008
    Date of Event
    September 18, 2008
    Report Date
    September 26, 2008
    Manufacturer
    ROCHE DIAGNOSTICS CORP.
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTED BLOOD GLUCOSE RESULTS OF HI, WHICH ON THE COMPACT PLUS SYSTEM INDICATES A RESULT IN EXCESS OF 600 MG/DL, AND 155 MG/DL WITHIN 10 MINUTES ON THE COMPACT PLUS SYSTEM. CUSTOMER 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-CHEK COMPACT TEST DRUM BLOOD GLUCOSE MONITORING TEST STRIPS -LFR LFR ROCHE DIAGNOSTICS CORP. 20679941

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR MULTIVITAMIN| ENALAPRIL: 15MG/DAY| ASPIRIN: 81 MG/DAY| VITAMIN C| LEVOXYL| LANTUS: 14 UNITS/DAY| CALCIUM| HUMALOG: SLIDING SCALE