BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK COMPACT TEST DRUM

    MDR report key: 1761314 · Received July 20, 2007

    Report

    Report Number
    1823260-2007-06372
    Event Type
    Malfunction
    Date Received
    July 20, 2007
    Date of Event
    July 13, 2007
    Report Date
    July 20, 2007
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MS, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTS BACK TO BACK BLOOD SUGARS OF 441 MG/DL AND 136 MG/DL WITHIN THREE MINUTES ON HER COMPACT SYSTEM. NO ACTIONS OR INACTIONS TAKEN BASED ON THE RESULTS. NO ADVERSE EVENTS REPORTED. REQUESTED RETURN OF SUSPECT DEVICE AND 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 20667342

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR HUMALOG - 25 UNTS BEFORE MEALS| LANTUS - 75 UNITS 6 PM