BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® AVIVA TEST STRIPS

    MDR report key: 1691721 · Received May 17, 2010

    Report

    Report Number
    1823260-2010-02967
    Event Type
    Malfunction
    Date Received
    May 17, 2010
    Date of Event
    May 7, 2010
    Report Date
    May 25, 2010
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K043474
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    IT WAS UNKNOWN IF THE INITIAL REPORTER SENT REPORT TO THE FDA.

    Description of Event or Problem · 1

    IT WAS REPORTED TO US THAT A LAUNCHER 7F (EBU3.75) WAS USED DURING THIS PROCEDURE. MEDTRONIC WAS MADE AWARE OF THIS INFO ON 05/05/2010. THREE ENDEAVOR RESOLUTE RX DRUG-ELUTING STENTS (2.25MM X 14MM, 2.50MM X 14MM, AND 3.50MM X 15MM) (REF MFR REPORT# 2953200-2010-00674, 2953200-2010-00675, 2953200-2010-00676) WERE INSERTED INTO A PT FOR TREATMENT OF A LEFT MAIN AND LAD. A 3.50 X 20 MM SPRINTER LEGEND RX BALLOON DILATATION CATHETER (MFR REPORT#: 2953200-2010-00863), A 4.00MM X 12MM NC SPRINTER RX BALLOON DILATATION CATHETER (MFR REPORT#: 2953200-2010-00864) LESION MORPHOLOGY WAS REPORTED AS SMALL CALCIFIED DIFFUSELY DISEASED CORONARY ARTERIES WITH SIGNIFICANT STENOSIS OF THE LEFT MAIN, PROXIMAL CX AND LAD/ORIGIN DIAGONAL. THE LAD/DIAGONAL WERE DILATED WITH GOBA (BALLOON ONLY). FOLLOWING PRE-DILATATION THE 2.25MM DIAMETER X 14MM LENGTH STENT WAS IMPLANTED AT THE PROXIMAL CX. STENTS WERE IMPLANTED IN THE LEFT MAIN AND ORIGIN LAD, FOLLOWED BY POST DILATATION TO 4 MM. THERE WAS A GOOD ANGIOGRAPHIC RESULT. THE POST OPERATIVE COURSE REPORTED EPISODES OF CHEST PAIN, TROPONIN RISE, HEART FAILURE, AND COLLAPSE AFTER 7 DAYS. IT IS REPORTED THAT THE PT HAD AN EMERGENCY RE-CATHETERIZATION. THE MAIN ARTERIES WERE OPEN BUT NO FILLING OF THE SMALL SIDE BRANCHES WERE OBSERVED. IT IS REPORTED THAT THE PT DIED A WEEK LATER. AN AUTOPSY WAS PERFORMED WHICH SHOWED EXTENSIVE MYOCARDIAL DAMAGE. DEVICES WERE NOT RECEIVED FOR EVAL. SEPARATE MDR'S HAVE BEEN FILED FOR EACH PRODUCT USED IN THIS CASE THEY ARE: ENDEAVOR RESOLUTE-REPORT#2953200-2010-00674 (B) (4), ENDEAVOR RESOLUTE-REPORT#2953200-2010-00675 (B) (4), ENDEAVOR RESOLUTE-REPORT#2953200-2010-00676 , (B) (4), SPRINTER LEGEND RX-REPORT#2953200-2010-00863 (B) (4), NC SPRINTER RX-REPORT#2953200-2010-00864 (B) (4), ZINGER LIGHT SUPPORT 180CM-REPORT# 1220452201000025 (B) (4).

    Description of Event or Problem · 1

    CALLER REPORTED AVIVA SYSTEM BLOOD GLUCOSE RESULTS OF 175 MG/DL, 192 MG/DL, AND 210 MG/DL, PROFESSIONAL RESULTS OF 101 MG/DL, 101 MG/DL, AND 101 MG/DL WITHIN 10 MINUTES. REPORTED NO ADVERSE EVENT RELATIVE TO DISCREPANCY. STRIPS NOT AVAILABLE FOR RETURN, REPLACEMENT SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK ® AVIVA TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 302065

    Patients

    Seq Age Sex Outcome Treatment
    1 062 YR GLYBURIDE| LANTUS