BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SOFTCLIX LANCET DEVICE

    MDR report key: 1772821 · Received October 17, 2007

    Report

    Report Number
    1823260-2007-09073
    Event Type
    Malfunction
    Date Received
    October 17, 2007
    Date of Event
    September 21, 2007
    Report Date
    October 17, 2007
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    FMK
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    LAY USER/PATIENT

    Narratives

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT THE LANCET WOULD NOT RETRACT INTO THE ACCU-CHEK SOFTCLIX LANCET DEVICE. THE CUSTOMER DID ACCIDENTALLY STICK HERSELF BUT DID NOT REQUIRE MEDICAL INTERVENTION. THE ACCU-CHEK CUSTOMER CARE SERVICE CENTER SENT NEW DEVICE. CUSTOMER ADVISED TO RETURN SUSPECT DEVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SOFTCLIX LANCET DEVICE LANCET DEVICE - FMK FMK ROCHE DIAGNOSTICS WIP817

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR