BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COAGUCHEK S SYSTEM

    MDR report key: 1761125 · Received July 13, 2007

    Report

    Report Number
    1823260-2007-06082
    Event Type
    Malfunction
    Date Received
    July 13, 2007
    Date of Event
    May 31, 2007
    Report Date
    July 13, 2007
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    JPA
    PMA / PMN Number
    K974569
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    CALLER STATES THE PATIENT TESTED 1.5 INR ON THE COAGUCHEK SYSTEM AND 2.6 INR ON A COMPARISON LAB. NO TREATMENT INFORMATION PROVIDED. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT SYSTEM AND REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COAGUCHEK S SYSTEM PROTHROMBIN TIME TEST STRIP - JPA JPA ROCHE DIAGNOSTICS 545A-D4

    Patients

    Seq Age Sex Outcome Treatment
    1 NA