BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MULTICLIX LANCET DEVICE

    MDR report key: 1761152 · Received July 19, 2007

    Report

    Report Number
    1823260-2007-06317
    Event Type
    Malfunction
    Date Received
    July 19, 2007
    Date of Event
    July 13, 2007
    Report Date
    July 19, 2007
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    FMK
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    CALLER STATES, THE LANCET DOES NOT RETRACT INTO THE MULTICLIX LANCET DEVICE AFTER FIRING. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT DEVICE AND REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MULTICLIX LANCET DEVICE LANCET DEVICE - FMK FMK ROCHE DIAGNOSTICS NI

    Patients

    Seq Age Sex Outcome Treatment
    1 11 YR