BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK MULTICLIX LANCETS

    MDR report key: 1200132 · Received October 15, 2008

    Report

    Report Number
    1823260-2008-07634
    Event Type
    Malfunction
    Date Received
    October 15, 2008
    Date of Event
    September 27, 2008
    Report Date
    October 15, 2008
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    FMK
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IA, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    REPORTER ALLEGED THAT THE MULTICLIX LANCET NEEDLE BROKE OFF INTO HIS THUMB. NO ACTION OR TREATMENT RESULTED. A REQUEST WAS MADE FOR THE RETURN OF THE SUSPECT DEVICE AND REPLACEMENT PRODUCT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK MULTICLIX LANCETS LANCET - FMK FMK ROCHE DIAGNOSTICS WP070082

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR NOVOLOG - 6 MONTHS - 16 UNITS WITH MEALS| LANTUS - 6 MONTHS - 45 UNITS NIGHTLY