BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK COMPACT TEST DRUM

    MDR report key: 1772016 · Received September 18, 2007

    Report

    Report Number
    1823260-2007-08146
    Event Type
    Malfunction
    Date Received
    September 18, 2007
    Date of Event
    August 28, 2007
    Report Date
    September 18, 2007
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER OBTAINED A RESULT OF 186 MG/DL ON HER ACCU-CHEK COMPACT METER IN COMPARISON TO A PROFESSIONAL METER RESULT OF 102 MG/DL. RESULTS WERE OBTAINED WITHIN 10 MINUTES. NO ACTION WAS TAKEN BASED ON THE READINGS. NO ADVERSE EVENT REPORTED. NEW SYSTEM SENT TO CUSTOMER AND RETURN REQUESTED.

    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 20653441

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR LIPITOR - 20 MG/DAY - 4 YEARS| LISINOPRIL - 20 MG/DAY| METFORMIN - 1000 MG/DAY - 4 YEARS| LEVOTHYROXINE - 50 MG/DAY - 4 YEARS| ZETIA - 2 MG/DAY - 1 YEAR